MEDICARE: CARL T WHALEN

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	2083X0100X	Occupational Medicine Physician	DO2024-0096	NM

General Provider Information

NPI Number	:	1609405315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL T WHALEN

Provider Business Mailing Address
First Line	:	3121 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1654
Country	:	US
Telephone Number	:	505-916-6544
Fax Number	:	505-205-1514

Provider Business Practice Location Address
First Line	:	3121 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1654
Country	:	US
Telephone Number	:	505-228-2108
Fax Number	:	505-205-1514

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

Provider Enumeration Date	:	04/04/2020
Last Update Date	:	07/25/2024

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