Healthcare Provider Details

I. General information

NPI: 1134145022
Provider Name (Legal Business Name): VAN L WHARTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WASHINGTON ST SUITE 468
NEWTON MA
02462-1650
US

IV. Provider business mailing address

61 CLARK RD
BROOKLINE MA
02445-6029
US

V. Phone/Fax

Practice location:
  • Phone: 617-965-6700
  • Fax:
Mailing address:
  • Phone: 617-965-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58991
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: