1831101419 NPI number — BONNY LYN WHALEN M.D.

Table of content: BONNY LYN WHALEN M.D. (NPI 1831101419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831101419 NPI number — BONNY LYN WHALEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHALEN
Provider First Name:
BONNY
Provider Middle Name:
LYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSTON
Provider Other First Name:
BONNY
Provider Other Middle Name:
LYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831101419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL CENTER DR.
Provider Second Line Business Mailing Address:
DHMC - DEPT OF PEDIATRICS - NEWBORN NURSERY
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03756-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-653-6081
Provider Business Mailing Address Fax Number:
603-650-0910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
DHMC DEPT OF PEDIATRICS - NEWBORN NURSERY
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03756-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-653-6081
Provider Business Practice Location Address Fax Number:
603-650-0910
Provider Enumeration Date:
08/12/2006

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: 208000000X , with the licence number:  12826 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3072323 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1011849 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".