Provider Demographics
NPI:1790870459
Name:WHEELER, THOMAS E (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BURNHAM
Mailing Address - State:PA
Mailing Address - Zip Code:17009-1827
Mailing Address - Country:US
Mailing Address - Phone:717-248-0821
Mailing Address - Fax:717-248-3162
Practice Address - Street 1:301 S LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:PA
Practice Address - Zip Code:17009-1827
Practice Address - Country:US
Practice Address - Phone:717-248-0821
Practice Address - Fax:717-248-3162
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001927L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010628120003Medicaid
PA475407TY2Medicare ID - Type Unspecified
PA0010628120003Medicaid