MEDICARE: DR. THOMAS JOSEPH WHALEN III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	97165	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	900521074	OTHER		MEDICARE PIN GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1114958790	OTHER		GROUP NPI

General Provider Information

NPI Number	:	1134120645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JOSEPH WHALEN III M.D.

Provider Business Mailing Address
First Line	:	3311 CANDELARIA RD NE STE K
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1952
Country	:	US
Telephone Number	:	505-246-9190
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 CANDELARIA RD NE STE K
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1952
Country	:	US
Telephone Number	:	505-246-9190
Fax Number	:	505-896-9461

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	11/02/2022

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Directions to “ DR. THOMAS JOSEPH WHALEN III M.D.” Practice Location

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