Basic Information
Provider Information
NPI: 1073669891
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WHEELOCK
FirstName: CHRISTOPHER
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2550 MOSSIDE BLVD STE 500
Address2:  
City: MONROEVILLE
State: PA
PostalCode: 151463514
CountryCode: US
TelephoneNumber: 4124571100
FaxNumber: 4124570250
Practice Location
Address1: 2550 MOSSIDE BLVD STE 500
Address2:  
City: MONROEVILLE
State: PA
PostalCode: 151463514
CountryCode: US
TelephoneNumber: 4124571100
FaxNumber: 4124570250
Other Information
ProviderEnumerationDate: 01/26/2007
LastUpdateDate: 10/12/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD475230PAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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