Healthcare Provider Details

I. General information

NPI: 1114958790
Provider Name (Legal Business Name): DR.THOMAS J WHALEN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8314 KASEMAN CT NE
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

21 VALERIE AVE
MONTPELIER VT
05602-3748
US

V. Phone/Fax

Practice location:
  • Phone: 505-246-9190
  • Fax: 505-246-9617
Mailing address:
  • Phone: 505-892-4461
  • Fax: 505-892-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberNM97165
License Number StateNM

VIII. Authorized Official

Name: THOMAS J WHALEN
Title or Position: PRESIDENT
Credential: MD
Phone: 505-246-9190