Healthcare Provider Details

I. General information

NPI: 1477519866
Provider Name (Legal Business Name): RICHARD H WHITTEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 BELMONT ST
WORCESTER MA
01605-2964
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-0001
US

V. Phone/Fax

Practice location:
  • Phone: 508-754-7018
  • Fax: 508-754-7044
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number36127
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: