Healthcare Provider Details

I. General information

NPI: 1689917361
Provider Name (Legal Business Name): ALEXANDER STUART WHITAKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 LINDEN AVE 1ST FLOOR
BALTIMORE MD
21201-4606
US

IV. Provider business mailing address

PO BOX 62063 DIVISION OF PEDIATRIC EDUCATION
BALTIMORE MD
21264-2063
US

V. Phone/Fax

Practice location:
  • Phone: 410-225-8780
  • Fax: 410-225-8766
Mailing address:
  • Phone: 410-706-5181
  • Fax: 410-706-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD81474
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: