Provider Demographics
NPI:1790815801
Name:WHEELER PLASTIC & RECONSTRUCTIVE SURGERY,INC
Entity Type:Organization
Organization Name:WHEELER PLASTIC & RECONSTRUCTIVE SURGERY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MD
Authorized Official - Phone:802-775-2588
Mailing Address - Street 1:92 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4562
Mailing Address - Country:US
Mailing Address - Phone:802-775-2588
Mailing Address - Fax:802-775-8062
Practice Address - Street 1:92 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4562
Practice Address - Country:US
Practice Address - Phone:802-775-2588
Practice Address - Fax:802-775-8062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420005701208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTDO3274VTMedicare UPIN