Healthcare Provider Details

I. General information

NPI: 1043202138
Provider Name (Legal Business Name): RICHARD B WHALEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 W SPRING ST SUITE 102
TITUSVILLE PA
16354-1655
US

IV. Provider business mailing address

339 W SPRING ST SUITE 102
TITUSVILLE PA
16354-1655
US

V. Phone/Fax

Practice location:
  • Phone: 814-827-9675
  • Fax: 814-827-0216
Mailing address:
  • Phone: 814-827-9675
  • Fax: 814-827-0216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD055364L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: