Provider Demographics
NPI:1831177732
Name:WELLS, LUTHER
Entity type:Individual
Prefix:
First Name:LUTHER
Middle Name:
Last Name:WELLS
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 1:629D LOWTHER RD
Mailing Address - Street 2:SUITE 3950
Mailing Address - City:LEWISBERRY
Mailing Address - State:PA
Mailing Address - Zip Code:17339-9527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:629D LOWTHER RD
Practice Address - Street 2:SUITE 3950
Practice Address - City:LEWISBERRY
Practice Address - State:PA
Practice Address - Zip Code:17339-9527
Practice Address - Country:US
Practice Address - Phone:717-932-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4238022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA91156OtherGEISINGER HEALTH PLAN
PA20033440OtherKEYSTONE MERCY
MD286821101Medicaid
PA153825OtherTHREE RIVERS
PA1616957OtherHIGHMARK BCBS
PAJ611-003OtherCAREFIRST
PAWE1616957OtherHIGHMARK BS ADV. PPO
PA1010467130001Medicaid
PA001616957OtherPREMIER BLUE SHIELD
PAP00203923OtherRR PIN
PA101046713-0001Medicaid
PA1543563OtherGATEWAY
PA1616957OtherHEALTHGUARD
PA20033440OtherAMERIHEALTH MERCY PAR
PA50043626OtherCAPITAL BLUE CROSS
PA001616957OtherPREMIER BLUE SHIELD
PA20033440OtherKEYSTONE MERCY
PAWE1616957OtherHIGHMARK BS ADV. PPO