Healthcare Provider Details

I. General information

NPI: 1629052667
Provider Name (Legal Business Name): GUY M WHALEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1732
US

IV. Provider business mailing address

3675 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1732
US

V. Phone/Fax

Practice location:
  • Phone: 716-972-0279
  • Fax: 716-972-0273
Mailing address:
  • Phone: 716-972-0279
  • Fax: 716-972-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number178512
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: