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General NPI Number Information
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NPI Number | 1417480625
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Entity Type | Individual
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Provider Name | ELIZABETH WHITHAM MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 1 HOAG DR
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4162
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Country | US
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Telephone | 949-416-5074
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Fax | 828-372-4511
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Provider Business Mailing Address
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Address Line | 500 SUPERIOR AVE FL 3
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3657
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Country | US
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Telephone | 949-764-8191
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Fax | 949-764-4268
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A173089
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 312747
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License Number State | LA
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