Healthcare Provider Details

I. General information

NPI: 1669507174
Provider Name (Legal Business Name): TIMOTHY WHELAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN ST
SPRINGFIELD MA
01199-1002
US

IV. Provider business mailing address

280 CHESTNUT ST
SPRINGFIELD MA
01199-1000
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-7035
  • Fax:
Mailing address:
  • Phone: 413-794-5700
  • Fax: 413-794-1629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4284
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: