1982686341 NPI number — JOHN C WHITING OD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982686341 NPI number — JOHN C WHITING OD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

WHITING

Provider First Name:

JOHN

Provider Middle Name:

C

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

OD

Provider Gender Code:

M

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:

1982686341

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/26/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

5 NEPONSET ST FL STREET12

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WORCESTER

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01606-2714

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

978-345-7398

Provider Business Mailing Address Fax Number:

978-353-0035

Provider First Line Business Practice Location Address:

64 BOYDEN RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

HOLDEN

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01520-2570

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

508-856-9599

Provider Business Practice Location Address Fax Number:

508-829-4988

Provider Enumeration Date:

11/18/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  3146 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 4652997 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 042472266 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
• Identifier: 47244 . This is a "CHILDRENS MEDICAL SECURIT" identifier . This identifiers is of the category "OTHER".
• Identifier: W16043 . This is a "BLUE CARE ELECT" identifier . This identifiers is of the category "OTHER".
• Identifier: 35481159 . This is a "CIGNA HEALTHSOURCE" identifier . This identifiers is of the category "OTHER".
• Identifier: 60890 . This is a "FALLON COMMUNITY HEALTH P" identifier . This identifiers is of the category "OTHER".
• Identifier: 785969 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 042472266 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 2213200 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: AA2170 . This is a "HARVARD PILGRIM HEALTHCAR" identifier . This identifiers is of the category "OTHER".
• Identifier: 042472266 . This is a "TRICARE CHAMPUS" identifier . This identifiers is of the category "OTHER".
• Identifier: 6037084002 . This is a "CIGNA PAL ID" identifier . This identifiers is of the category "OTHER".
• Identifier: W16043 . This is a "BLUE SHIELD HMO BLUE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0334910 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: B291197401 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".