Provider Demographics
NPI:1295574754
Name:WINGLER, THADDEUS BENTON
Entity type:Individual
Prefix:
First Name:THADDEUS
Middle Name:BENTON
Last Name:WINGLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:MAXWELTON
Mailing Address - State:WV
Mailing Address - Zip Code:24957-8066
Mailing Address - Country:US
Mailing Address - Phone:888-736-3229
Mailing Address - Fax:304-497-0516
Practice Address - Street 1:804 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:MAXWELTON
Practice Address - State:WV
Practice Address - Zip Code:24957-8066
Practice Address - Country:US
Practice Address - Phone:888-736-3229
Practice Address - Fax:304-497-0516
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist