Provider Demographics
NPI:1871587428
Name:HARRELL, THOMAS WESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WESLEY
Last Name:HARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MDG
Mailing Address - Street 2:UNIT 5210
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09464
Mailing Address - Country:US
Mailing Address - Phone:0114-416-3852
Mailing Address - Fax:
Practice Address - Street 1:48 MDG
Practice Address - Street 2:UNIT 5210
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09464
Practice Address - Country:US
Practice Address - Phone:0114-416-3852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36325207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease