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General NPI Number Information
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NPI Number | 1619273042
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Entity Type | Individual
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Provider Name | TARA WHELAN DO
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Gender | Female
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Dates
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Enumeration Date | 02/02/2011
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 45 WELLS ST SUITE 201
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City | WESTERLY
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State | RI
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Zip | 02891-2961
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Country | US
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Telephone | 401-315-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 35 BOOMBRIDGE RD
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City | WESTERLY
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State | RI
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Zip | 02891-1012
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Country | US
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Telephone | 401-575-7113
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | DO00708
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License Number State | RI
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