Provider Demographics
NPI:1114958790
Name:DR.THOMAS J WHALEN MD PC
Entity Type:Organization
Organization Name:DR.THOMAS J WHALEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-246-9190
Mailing Address - Street 1:21 VALERIE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3748
Mailing Address - Country:US
Mailing Address - Phone:505-892-4461
Mailing Address - Fax:505-892-4461
Practice Address - Street 1:8314 KASEMAN CT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-246-9190
Practice Address - Fax:505-246-9617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. THOMAS J WHALEN MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM97165207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NML9727Medicaid
NM900521074Medicare PIN