Basic Information
Provider Information
NPI: 1831177732
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WELLS
FirstName: LUTHER
MiddleName:  
NamePrefix: DR.
NameSuffix: JR.
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 629-D LOWTHER ROAD
Address2:  
City: LEWISBERRY
State: PA
PostalCode: 173399527
CountryCode: US
TelephoneNumber: 7179325200
FaxNumber: 7179323095
Practice Location
Address1: 629-D LOWTHER ROAD
Address2:  
City: LEWISBERRY
State: PA
PostalCode: 173399527
CountryCode: US
TelephoneNumber: 7179325200
FaxNumber: 7179323095
Other Information
ProviderEnumerationDate: 01/03/2006
LastUpdateDate: 01/17/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XMD423802PAY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

ID Information
IDTypeStateIssuerDescription
9115601PAGEISINGER HEALTH PLANOTHER
2003344001PAKEYSTONE MERCYOTHER
28682110105MD MEDICAID
15382501PATHREE RIVERSOTHER
161695701PAHIGHMARK BCBSOTHER
J611-00301PACAREFIRSTOTHER
WE161695701PAHIGHMARK BS ADV. PPOOTHER
101046713000105PA MEDICAID
00161695701PAPREMIER BLUE SHIELDOTHER
P0020392301PARR PINOTHER
101046713-000105PA MEDICAID
154356301PAGATEWAYOTHER
161695701PAHEALTHGUARDOTHER
2003344001PAAMERIHEALTH MERCY PAROTHER
5004362601PACAPITAL BLUE CROSSOTHER


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