Provider Demographics
NPI:1114079365
Name:WHITAKER, ALBERT JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:
Last Name:WHITAKER
Suffix:JR
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 1:224 SOUTH NEW HOPE RD.
Mailing Address - Street 2:SUITE K
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0020
Mailing Address - Country:US
Mailing Address - Phone:704-867-7494
Mailing Address - Fax:704-867-7432
Practice Address - Street 1:224 S NEW HOPE RD
Practice Address - Street 2:SUITE K
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4873
Practice Address - Country:US
Practice Address - Phone:704-867-7494
Practice Address - Fax:704-867-7432
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23244208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC86901OtherBCBSNC
NC8986901Medicaid
NC8986901Medicaid
NC202241Medicare ID - Type Unspecified