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Organization
THOMAS RUSSELL WIETERS, M.D., P.A.
Active
Organization
THOMAS RUSSELL WIETERS, M.D., P.A.
Active
Other names
The Vein Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS RUSSELL WIETERS M.D. (OWNER)
(843) 881-8346
Entity
Organization
Contact information
Practice address
3070 HIGHWAY 17 N, SUITE 202, MOUNT PLEASANT, SC 29466-9300
(843) 881-8346
(843) 284-4093
Mailing address
3070 HIGHWAY 17 N, SUITE 202, MOUNT PLEASANT, SC 29466-9300
(843) 881-8346
(843) 284-4093
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
10486
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104862
—
SC
Enumeration date
12/04/2007
Last updated
03/19/2008
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