1033261102 NPI number — DR. ELIZABETH V WHEELER PHD

Table of content: DR. ELIZABETH V WHEELER PHD (NPI 1033261102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033261102 NPI number — DR. ELIZABETH V WHEELER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEELER
Provider First Name:
ELIZABETH
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033261102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 MIDDLE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-712-1853
Provider Business Mailing Address Fax Number:
207-773-5512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 MIDDLE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-712-1853
Provider Business Practice Location Address Fax Number:
207-773-5512
Provider Enumeration Date:
01/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PS1130 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X , with the licence number: PS1130 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 017608 . This is a "VALUE OPTIONS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 431546200 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 048089 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".