Healthcare Provider Details

I. General information

NPI: 1720043227
Provider Name (Legal Business Name): THOMAS PATRICK WHELAN M.D..
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ELIZABETH ST
BETHEL CT
06801-2100
US

IV. Provider business mailing address

2 ELIZABETH ST
BETHEL CT
06801-2100
US

V. Phone/Fax

Practice location:
  • Phone: 203-791-2221
  • Fax: 203-791-0682
Mailing address:
  • Phone: 203-791-2221
  • Fax: 203-791-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number029121
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: