Healthcare Provider Details

I. General information

NPI: 1396968830
Provider Name (Legal Business Name): J.M. WHEATLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ARMORY PLACE SUITE 3D, ARMORY BUILDING, MARYLAND GENERAL HOSPITAL
BALTIMORE MD
21212-2612
US

IV. Provider business mailing address

PO BOX 621
LEONARDTOWN MD
20650-0621
US

V. Phone/Fax

Practice location:
  • Phone: 301-997-0191
  • Fax: 301-997-0199
Mailing address:
  • Phone: 301-997-0191
  • Fax: 301-997-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JON CIECKA
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-997-0191