MEDICARE: DR. KRISTENE E WHITMORE 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	208800000X	Urology Physician	MD035368E	PA
2	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician	MD035368E	PA
3	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician	25MA05118900	NJ

General Provider Information

NPI Number	:	1407905383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTENE E WHITMORE M.D.

Provider Business Mailing Address
First Line	:	301 LIPPINCOTT DR STE 410
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-4197
Country	:	US
Telephone Number	:	856-355-0340
Fax Number	:	856-355-0330

Provider Business Practice Location Address
First Line	:	1945 ROUTE 70 E STE A
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-2160
Country	:	US
Telephone Number	:	856-247-7420
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	10/04/2024

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