Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC009037 | PA |
Y | 213ER0200X | Radiology | DC009037 | PA |
NPI | 1952359556 |
---|---|
Provider Name | Dr. Matthew Wells |
First Address | Dunbar, PA 15431-2305 |
Second Address | Dunbar, PA 15431-2305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 20/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019639440002 | (05) | PA |
U96348 | (02) | PA |