Provider Demographics
NPI:1457358244
Name:WHEELING, THERESA A (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:WHEELING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11277 VERNON PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3717
Mailing Address - Country:US
Mailing Address - Phone:814-724-1252
Mailing Address - Fax:814-337-6043
Practice Address - Street 1:11277 VERNON PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3717
Practice Address - Country:US
Practice Address - Phone:814-724-1252
Practice Address - Fax:814-337-6043
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052438L2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015803900004Medicaid
PAWH067636Medicare ID - Type Unspecified
PA0015803900004Medicaid