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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