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General NPI Number Information
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NPI Number | 1467517243
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Entity Type | Organization
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Legal Business Name | ELIZABETH A WHALEN MD LLC
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 09/28/2007
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Provider Practice Location Address
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Address Line | 200 KENNEDY DR
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City | TORRINGTON
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State | CT
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Zip | 06790-3096
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Country | US
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Telephone | 860-489-6718
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Fax | 860-489-8270
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Provider Business Mailing Address
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Address Line | PO BOX 150473 DEPT. 445
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City | HARTFORD
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State | CT
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Zip | 06115-0473
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Country | US
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Telephone | 860-489-6718
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Fax | 860-489-8270
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Authorized Official
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Title or Position | MEMBER, ELIZABETH A. WHALEN, MD, LL
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Name | DR. ELIZABETH A WHALEN
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Credential | M.D.
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Telephone | 860-489-6718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 032771
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License Number State | CT
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