MEDICARE: RICHARD B WHALEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD055364L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043202138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD B WHALEN MD

Provider Business Mailing Address
First Line	:	339 W SPRING ST
Second Line	:	SUITE 102
City	:	TITUSVILLE
State	:	PA
Zip	:	16354-1655
Country	:	US
Telephone Number	:	814-827-9675
Fax Number	:	814-827-0216

Provider Business Practice Location Address
First Line	:	339 W SPRING ST
Second Line	:	SUITE 102
City	:	TITUSVILLE
State	:	PA
Zip	:	16354-1655
Country	:	US
Telephone Number	:	814-827-9675
Fax Number	:	814-827-0216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	07/08/2007

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