Healthcare Provider Details

I. General information

NPI: 1760461180
Provider Name (Legal Business Name): JOSEPH D. WHITLARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 UNIVERSITY DR
STATE COLLEGE PA
16801-6626
US

IV. Provider business mailing address

905 UNIVERSITY DR
STATE COLLEGE PA
16801-6626
US

V. Phone/Fax

Practice location:
  • Phone: 814-238-8418
  • Fax: 814-234-2888
Mailing address:
  • Phone: 814-238-8418
  • Fax: 814-234-2888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number000722778
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number000722778
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number000722778
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD039559E
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD039559E
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD039559E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier12953
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBLUE CROSS
# 2
Identifier8912953
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier2293437A
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerMEDICARE ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: