Healthcare Provider Details

I. General information

NPI: 1033110523
Provider Name (Legal Business Name): MAYNARD B WHEELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 PLEASANT STREET SUITE 1600
CONCORD NH
03301-2588
US

IV. Provider business mailing address

248 PLEASANT STREET SUITE 1600
CONCORD NH
03301-2588
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-2020
  • Fax: 603-228-0248
Mailing address:
  • Phone: 603-224-2020
  • Fax: 603-228-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number11342
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: