Healthcare Provider Details

I. General information

NPI: 1124011523
Provider Name (Legal Business Name): MARCUS CRAIG WHALEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 DR MARTIN LUTHER KING JR BLVD
NEW BERN NC
28562-4238
US

IV. Provider business mailing address

PO BOX 896206
CHARLOTTE NC
28289-6206
US

V. Phone/Fax

Practice location:
  • Phone: 252-636-1919
  • Fax: 252-636-2656
Mailing address:
  • Phone: 252-636-1919
  • Fax: 252-636-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200300105
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: