=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134245954
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES J WHALEN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 12/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 BLACKSTONE VALLEY PL BLDG 4, SUITE 401
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02865-1179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-333-3435
-----------------------------------------------------
Fax | 401-333-6434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 REGINA DR
-----------------------------------------------------
City | NORTH SCITUATE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02857-1080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-647-0488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 8487
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | LT4233
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------