Provider Demographics
NPI:1073592689
Name:WHITMORE, PAUL VERNON (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:VERNON
Last Name:WHITMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:19103 GUNNERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1527
Mailing Address - Country:US
Mailing Address - Phone:304-236-0811
Mailing Address - Fax:304-579-2570
Practice Address - Street 1:510 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9990
Practice Address - Country:US
Practice Address - Phone:304-263-0811
Practice Address - Fax:304-579-2570
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD25820207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD25820OtherMEDICAL LICENSE
MI4301027776OtherMEDICAL LICENSE
DCDO5926Medicare UPIN