Provider Demographics
NPI:1073831442
Name:WHITWORTH, WALTER RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:RICHARD
Last Name:WHITWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 SAINT JUDE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3670
Mailing Address - Country:US
Mailing Address - Phone:336-954-7546
Mailing Address - Fax:336-235-4018
Practice Address - Street 1:2704 SAINT JUDE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3670
Practice Address - Country:US
Practice Address - Phone:336-954-7546
Practice Address - Fax:336-235-4018
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201400301207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology