Healthcare Provider Details

I. General information

NPI: 1225826712
Provider Name (Legal Business Name): WHSP MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GUEST ST STE 200
BRIGHTON MA
02135-2040
US

IV. Provider business mailing address

20 GUEST ST STE 200
BRIGHTON MA
02135-2040
US

V. Phone/Fax

Practice location:
  • Phone: 215-694-7158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN E ACKERMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 215-694-7158