MEDICARE: DR. JOSEPH D. WHITLARK 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	208600000X	Surgery Physician	000722778	NC
2	2086S0129X	Vascular Surgery Physician	000722778	NC
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	000722778	NC
4	225100000X	Physical Therapist
5	2471V0105X	Vascular Sonography Radiologic Technologist
6	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MD039559E	PA
7	2086S0129X	Vascular Surgery Physician	MD039559E	PA
8	208600000X	Surgery Physician	MD039559E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	2293437A	OTHER	NC	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12953	OTHER	NC	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760461180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH D. WHITLARK MD

Provider Business Mailing Address
First Line	:	905 UNIVERSITY DR
Second Line	:
City	:	STATE COLLEGE
State	:	PA
Zip	:	16801-6626
Country	:	US
Telephone Number	:	814-238-8418
Fax Number	:	814-234-2888

Provider Business Practice Location Address
First Line	:	905 UNIVERSITY DR
Second Line	:
City	:	STATE COLLEGE
State	:	PA
Zip	:	16801-6626
Country	:	US
Telephone Number	:	814-238-8418
Fax Number	:	814-234-2888

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	11/18/2015

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