Healthcare Provider Details

I. General information

NPI: 1003433087
Provider Name (Legal Business Name): ARIEL THETYS WAMPLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MAIN ST STE 202
FLORENCE MA
01062-3100
US

IV. Provider business mailing address

40 MAIN ST STE 202
FLORENCE MA
01062-3100
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-0044
  • Fax:
Mailing address:
  • Phone: 413-584-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number1026103
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: