Healthcare Provider Details

I. General information

NPI: 1477848497
Provider Name (Legal Business Name): JILL BRADLEY WHELAN M.D., F.A.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 11/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 RESNIK RD
PLYMOUTH MA
02360-7211
US

IV. Provider business mailing address

30 RESNIK RD
PLYMOUTH MA
02360-7211
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-2900
  • Fax: 508-746-4208
Mailing address:
  • Phone: 508-746-2900
  • Fax: 508-746-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number269518
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number248904
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: