Provider Demographics
NPI:1295898641
Name:WHEELER, GLEN (MD)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:
Last Name:WHEELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:WEST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02574
Mailing Address - Country:US
Mailing Address - Phone:508-821-7731
Mailing Address - Fax:508-821-4688
Practice Address - Street 1:2007 BAY STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780
Practice Address - Country:US
Practice Address - Phone:508-821-7731
Practice Address - Fax:508-821-4688
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79939207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
079939OtherTUFTS HEALTH PLAN
9157891OtherCIGNA HEALTH CARE
MA0116149Medicaid
412871OtherPHCS
7190101OtherAETNA USHC NON HMO
MA0013265OtherTRICARE CHAMPUS
RI22245OtherBCBS
2291716OtherAETNA USHC HMO GROUP
0090151OtherHEALTHY START PROGRAM MA
MAM17398OtherBCBS GROUP
000000026441OtherBMC HEALTHNET PLAN
137062OtherHARVARD PILGRIM
MAJ18446OtherBCBS
2316139OtherAETNA USHC HMO
407279OtherBLUE CHIP COORD PARTNERS
MAM17398OtherBCBS GROUP
MA0116149Medicaid