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General NPI Number Information
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NPI Number | 1659350908
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Entity Type | Individual
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Provider Name | HERBERT WHITLEY MD
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Gender | Male
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Dates
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Enumeration Date | 01/14/2006
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Last Update Date | 08/12/2011
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Provider Practice Location Address
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Address Line | 102 HIGHLAND AVE SE
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City | ROANOKE
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State | VA
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Zip | 24013-2255
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Country | US
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Telephone | 540-224-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 1928 SPRINGMILL RD
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City | SALEM
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State | VA
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Zip | 24153-4703
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Country | US
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Telephone |
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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 | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 0101-231079
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License Number State | VA
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