Provider Demographics
NPI:1902896079
Name:WHEELER, AMY ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ELLEN
Last Name:WHEELER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:781-485-6000
Mailing Address - Fax:781-485-6391
Practice Address - Street 1:300 OCEAN AVE
Practice Address - Street 2:REVERE HEALTHCARE CENTER
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3675
Practice Address - Country:US
Practice Address - Phone:781-485-6000
Practice Address - Fax:781-485-6200
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2012-11-06
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Provider Licenses
StateLicense IDTaxonomies
MA159948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA159948OtherTUFTS HEALTH PLAN
MAJ21082OtherBCBS MA
MA3193934Medicaid
MA3193934Medicaid
MAJ21082OtherBCBS MA