1164869640 NPI number — KARINA WHELAN MD

Table of content: KARINA WHELAN MD (NPI 1164869640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164869640 NPI number — KARINA WHELAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHELAN
Provider First Name:
KARINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164869640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5034 OLD CLINIC BUILDING CB# 7110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27599-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-966-2276
Provider Business Mailing Address Fax Number:
919-966-2274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 MASON FARM RD STE 3100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
984-974-4462
Provider Business Practice Location Address Fax Number:
919-843-9355
Provider Enumeration Date:
05/24/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2018-00752 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)