Healthcare Provider Details

I. General information

NPI: 1669431979
Provider Name (Legal Business Name): MICHAEL WHITLOW M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 MADISON AVE
NEW YORK NY
10022-1009
US

IV. Provider business mailing address

255 E. 49TH ST. #16D
NEW YORK NY
10017
US

V. Phone/Fax

Practice location:
  • Phone: 212-753-5382
  • Fax: 212-308-6847
Mailing address:
  • Phone: 212-371-2558
  • Fax: 212-308-6847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number174606
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number174606
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: