Healthcare Provider Details

I. General information

NPI: 1437157294
Provider Name (Legal Business Name): RICHARD WHITNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MESSIMER DR
NEWARK OH
43055-3627
US

IV. Provider business mailing address

200 MESSIMER DR
NEWARK OH
43055-3627
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4870
  • Fax: 220-564-4871
Mailing address:
  • Phone: 220-564-4870
  • Fax: 220-564-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number35-079914
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: