MEDICARE: ANN E WHITAKER PA

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	363AS0400X	Surgical Physician Assistant	103102	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	970017587	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0656817	OTHER	NC	UNITED HEALTHCARE
2	79535	OTHER	NC	BLUE CROSS BLUE SHEILD NC
3	A5441	OTHER	NC	MEDCOST
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386618379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN E WHITAKER PA

Provider Business Mailing Address
First Line	:	4101 N ROXBORO ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2121
Country	:	US
Telephone Number	:	919-684-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3480 WAKE FOREST RD
Second Line	:	SUITE 500
City	:	RALEIGH
State	:	NC
Zip	:	27609-7376
Country	:	US
Telephone Number	:	919-862-5650
Fax Number	:

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	08/12/2008

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Directions to “ ANN E WHITAKER PA” Practice Location

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