Active NPI 1477647220 Individual Practitioner Male Practitioner

Dr. Wesley Paul Thayer , MD

Plastic Surgery • Nashville, TN

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Wesley Thayer, MD is a certified Plastic Surgery practicing in Nashville, TN. With approximately 26 years of clinical experience since graduating from Emory University School Of Medicine in 2000, Dr. Thayer delivers high-quality medical care to the local community at D-4207 MEDICAL CENTER NORTH.

Dr. Thayer is affiliated with Vanderbilt University Medical Center and accepts Medicare assignment.

Frequently performed procedures and clinical services include new patient outpatient office visit, preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less, complicated repair of wound of scalp, arms, or legs, 1.1-2.5 cm. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

D-4207 Medical Center North
Vanderbilt Medical Center

Nashville, TN 372322345

Telephone 6159363759

Fax 6159360167

Associated Practice Facility / Clinic

🏢 Mcv Associated Physicians Facility NPI 1710959457

Medicare Profile & Education

Medical School

Emory University School Of Medicine

Graduation Year

2000

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Plastic Surgery in Nashville, TN

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

26 Yrs +1.3 yrs vs City Avg

City Avg: 24.7 Yrs

State Avg: 29.2 Yrs

Regional Practice Density

31 Specialists

Practicing in Nashville, TN (110 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

73.7% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Thayer (26 Years) 26 Yrs

Nashville Specialty Average (24.7 Years) 24.7 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	36	36	$492.00	$147.59
15004 Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less	20	18	$1327.63	$239.90
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	19	19	$492.00	$128.30
13120 Complicated repair of wound of scalp, arms, or legs, 1.1-2.5 cm	18	18	$878.00	$301.40
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	16	14	$2114.00	$533.11
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	15	14	$751.00	$149.48
13131 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm	13	13	$970.00	$278.54
13100 Complicated repair of wound of trunk, 1.1-2.5 cm	11	11	$867.02	$319.04
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	11	11	$3154.00	$805.28

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	32	32	$492.00	$149.26
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	29	27	$751.00	$124.07
13120 Complicated repair of wound of scalp, arms, or legs, 1.1-2.5 cm	26	25	$878.00	$310.01
13100 Complicated repair of wound of trunk, 1.1-2.5 cm	19	19	$844.00	$294.03
99221 Initial hospital inpatient care per day, typically 30 minutes	19	19	$423.00	$78.27
13131 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm	19	19	$978.68	$298.53
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	18	16	$1073.00	$370.23
11403 Removal of noncancer skin growth of body, arms, or legs, 2.1-3.0 cm	16	16	$499.00	$91.77
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	15	15	$1208.53	$336.58
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	15	15	$492.00	$126.03
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	14	13	$126.00	$52.76
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	13	11	$2114.00	$524.00
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	12	12	$434.00	$79.75

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	36	36	$316.00	$100.29
13131 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm	23	23	$970.00	$269.74
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	23	22	$751.00	$127.38
13120 Complicated repair of wound of scalp, arms, or legs, 1.1-2.5 cm	22	22	$878.00	$294.13
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	21	21	$492.00	$149.80
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	19	19	$316.00	$77.64
13100 Complicated repair of wound of trunk, 1.1-2.5 cm	18	18	$844.00	$312.95
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	16	13	$126.00	$50.63
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	15	14	$2114.00	$617.43
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	15	12	$2114.00	$516.31
15100 Partial thickness self skin graft to trunk, arms, or legs, 100.0 sq cm or 1% body area for infants and children, or less	15	15	$2671.00	$539.10
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	14	13	$1073.00	$351.88
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	14	12	$2980.00	$684.90
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	12	12	$1196.00	$322.33
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	12	12	$126.00	$31.59
15002 Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)	12	11	$1045.00	$186.98
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	11	11	$3154.00	$841.70

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	56	56	$316.00	$100.64
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	43	43	$316.00	$78.28
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	23	23	$126.00	$51.63
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	23	20	$126.00	$32.03
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	20	19	$2980.00	$771.16
13131 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm	20	20	$970.00	$270.36
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	19	19	$2391.00	$440.85
13120 Complicated repair of wound of scalp, arms, or legs, 1.1-2.5 cm	18	17	$878.00	$312.69
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	17	17	$751.00	$121.32
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	16	16	$1196.00	$342.23
15100 Partial thickness self skin graft to trunk, arms, or legs, 100.0 sq cm or 1% body area for infants and children, or less	16	15	$2671.00	$553.37
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	15	15	$3154.00	$794.74
14061 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm	15	15	$2768.00	$859.42
13100 Complicated repair of wound of trunk, 1.1-2.5 cm	14	14	$844.00	$287.25
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	14	14	$2114.00	$625.28
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	13	13	$3154.00	$795.95
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	13	11	$2114.00	$576.72
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	12	12	$1073.00	$314.72

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	45	45	$292.36	$70.12
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	41	41	$292.17	$100.85
14302 Repair of wound by transferring skin, each additional 30.0 sq cm	36	13	$717.00	$209.77
15100 Partial thickness self skin graft to trunk, arms, or legs, 100.0 sq cm or 1% body area for infants and children, or less	29	25	$2671.00	$546.21
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	26	19	$2114.00	$519.20
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	24	18	$118.13	$24.93
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	21	20	$2980.00	$801.62
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	21	21	$3154.00	$870.27
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	17	16	$2391.00	$387.42
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	16	15	$3154.00	$773.93
15002 Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)	16	15	$1045.00	$214.62
15004 Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less	15	15	$1235.00	$258.99
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	14	13	$2962.00	$452.37
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	13	13	$2114.00	$626.81
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	13	13	$1196.00	$384.45
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	12	11	$751.00	$133.65
13120 Complicated repair of wound of scalp, arms, or legs, 1.1-2.5 cm	11	11	$878.00	$306.90

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
14302 Repair of wound by transferring skin, each additional 30.0 sq cm	58	12	$717.00	$209.85
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	43	43	$260.00	$96.35
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	33	22	$105.00	$24.50
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	31	31	$260.00	$72.81
15100 Partial thickness self skin graft to trunk, arms, or legs, 100.0 sq cm or 1% body area for infants and children, or less	22	18	$2671.00	$554.41
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	19	16	$3027.05	$724.68
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	19	17	$2114.00	$613.25
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	18	18	$3154.00	$842.66
14040 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.0 sq cm or less	16	15	$2079.00	$475.53
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	14	13	$2962.00	$402.31
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	14	12	$2114.00	$505.31
13131 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm	12	11	$970.00	$343.91
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	11	11	$1196.00	$389.87

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
15003 Preparation of graft site at trunk, arms, or legs	101	11	$221.04	$41.08
15101 Partial thickness skin graft at trunk, arms, or legs (additional 100 sq cm, or 1% body are of infants and children)	93	15	$566.00	$97.97
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	61	61	$255.54	$71.28
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	40	33	$103.35	$24.11
15100 Partial thickness self skin graft to trunk, arms, or legs, 100.0 sq cm or 1% body area for infants and children, or less	32	29	$2613.25	$493.34
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	29	29	$256.14	$97.64
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	24	22	$2911.63	$534.78
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	18	18	$2069.33	$699.77
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	17	17	$3119.06	$887.41
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	15	14	$1175.73	$188.00
15002 Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)	15	13	$1027.40	$191.70
13131 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm	14	14	$954.50	$343.26
11403 Removal of noncancer skin growth of body, arms, or legs, 2.1-3.0 cm	14	12	$489.86	$88.83
15738 Muscle flap wound repair of leg	12	11	$4368.33	$1080.56
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	11	11	$2071.36	$442.77
15240 Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)	11	11	$2837.82	$640.84

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	51	41	$102.00	$24.10
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	46	46	$388.00	$122.39
15101 Partial thickness skin graft at trunk, arms, or legs (additional 100 sq cm, or 1% body are of infants and children)	43	17	$560.00	$102.69
15003 Preparation of graft site at trunk, arms, or legs	40	16	$220.00	$42.79
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	35	35	$252.00	$69.09
15100 Partial thickness self skin graft to trunk, arms, or legs, 100.0 sq cm or 1% body area for infants and children, or less	32	30	$2587.00	$565.37
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	29	29	$252.00	$95.91
15002 Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)	24	23	$1012.00	$212.59
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	22	22	$2047.00	$636.39
99213 Established patient office or other outpatient visit, typically 15 minutes	22	20	$170.00	$48.32
15120 Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)	22	21	$2869.00	$423.88
15004 Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less	19	18	$1196.00	$255.10
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	17	17	$3055.00	$936.25
14301 Repair of wound by transferring skin, 30.1-60.0 sq cm	16	16	$2886.00	$696.79
15738 Muscle flap wound repair of leg	15	11	$4310.00	$916.61
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	14	12	$2047.00	$466.07

Medical Specialties & State Licenses

CMS Verified: 2026-06-09

Plastic Surgery Primary Specialty

NUCC Taxonomy Code: 208200000X

State License VA 0101231636

A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.

Surgery - Surgery of the Hand

NUCC Taxonomy Code: 2086S0105X

State License VA 0101231636

A surgeon with expertise in the investigation, preservation and restoration by medical, surgical and rehabilitative means, of all structures of the upper extremity directly affecting the form and function of the hand and wrist.

Surgery

NUCC Taxonomy Code: 208600000X

State License VA 0101231636

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

Surgery - Plastic and Reconstructive Surgery

NUCC Taxonomy Code: 2086S0122X

State License TN 39708

A surgeon who specializes in plastic and reconstructive surgery.

Hospital & Practice Group Affiliations

Vanderbilt University Medical Center

2107 Edward Curd Lane, Franklin, TN 370675615

Phone: 6155919890

Vanderbilt University Medical Center

2105 Edward Curd Lane, Franklin, TN 370675615

Phone: 6157948700

Vanderbilt University Medical Center

300 Steam Plant Rd, Gallatin, TN 370663032

Phone: 6159363475

Vanderbilt University Medical Center

1301 Medical Ctr Dr, Nashville, TN 372320028

Phone: 6153225000

Vanderbilt University Medical Center

343 Franklin Rd, Brentwood, TN 370275250

Vanderbilt University Medical Center

719 Thompson Ln, Nashville, TN 372043609

Phone: 6153223000

Secondary Practice Locations

11958 W Broad St

Richmond, VA 232331007

Phone: 8048283030

1250 E Marshall St

Richmond, VA 232985023

Phone: 8048283030

1213 E Clay St

Richmond, VA 232985071

Phone: 8048283030

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners

Dr. Stephane Braun , MD

Plastic Surgery

NPI 1023192135

Doctor of Medicine (M.D.)

Dr. Michaela Hitchner , MD, MPH

Student in an Organized Health Care Education/Training Program

NPI 1215783808

Doctor of Medicine (M.D.), Master of Public Health

Dr. Melanie Jones , MD

Student in an Organized Health Care Education/Training Program

NPI 1255269825

Doctor of Medicine (M.D.)

Dr. Bachar Chaya , MD

Student in an Organized Health Care Education/Training Program

NPI 1578255857

Doctor of Medicine (M.D.)

Kiran Mahapure , MDMSMCH

Student in an Organized Health Care Education/Training Program

NPI 1588353809

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

11 Historical Events

📍

Updated Business Mailing Address June 09, 2026

Registered at PO BOX 780125, PHILADELPHIA, PA 191780125 (Tel: 8049224844)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) June 09, 2026

Plastic Surgery (License #0101231636 in VA)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 10, 2023

Plastic Surgery (License #39708 in TN)

📍

Updated Business Mailing Address March 14, 2022

Registered at 3841 GREEN HILLS VILLAGE DR STE 200, NASHVILLE, TN 372152691 (Tel: 6159363759)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) March 14, 2022

Surgery (License #39708 in TN)

✅

NPI Profile Active September 30, 2014

NPI status registered as active in NPPES database

📍

Updated Practice Location September 30, 2014

Registered at D-4207 MEDICAL CENTER NORTH, VANDERBILT MEDICAL CENTER, NASHVILLE, TN 372322345 (Tel: 6159363759)

📍

Updated Business Mailing Address September 30, 2014

Registered at 1161 21ST AVE S, D-4207 MEDICAL CENTER NORTH, NASHVILLE, TN 372322345 (Tel: 6159363759)

👤

Provider Name / Credentials Updated September 30, 2014

Recorded as WESLEY THAYER, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) September 30, 2014

Plastic Surgery (License #39708 in TN)

🟢

Initial NPI Registration & Enumeration October 03, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1477647220

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: October 03, 2006

Last Update: June 09, 2026

Sole Proprietor: No

Update or Correct Profile

Mailing Address

Po Box 780125

Philadelphia, PA 191780125

Phone: 8049224844

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.