Healthcare Provider Details

I. General information

NPI: 1841248473
Provider Name (Legal Business Name): JOSEPH GIBSON WHELAN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 E MOREHEAD ST
CHARLOTTE NC
28207-1606
US

IV. Provider business mailing address

1524 E MOREHEAD ST
CHARLOTTE NC
28207-1606
US

V. Phone/Fax

Practice location:
  • Phone: 704-343-3400
  • Fax: 704-343-3428
Mailing address:
  • Phone: 704-343-3400
  • Fax: 704-343-3428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number200400176
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: