Healthcare Provider Details

I. General information

NPI: 1730162140
Provider Name (Legal Business Name): ALBERT SIDNEY WHITING JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 MAIN ST
CARIBOU ME
04736-4464
US

IV. Provider business mailing address

PO BOX 576
CARIBOU ME
04736-0576
US

V. Phone/Fax

Practice location:
  • Phone: 207-496-6851
  • Fax: 207-492-5791
Mailing address:
  • Phone: 207-496-6851
  • Fax: 207-492-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number200100197
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD17756
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: