Provider Demographics
NPI:1134120645
Name:WHALEN, THOMAS JOSEPH III (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:WHALEN
Suffix:III
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 1:3311 CANDELARIA RD NE STE K
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1952
Mailing Address - Country:US
Mailing Address - Phone:505-246-9190
Mailing Address - Fax:
Practice Address - Street 1:3311 CANDELARIA RD NE STE K
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1952
Practice Address - Country:US
Practice Address - Phone:505-246-9190
Practice Address - Fax:505-896-9461
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97165207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NML9727Medicaid
1114958790OtherGROUP NPI
900521074OtherMEDICARE PIN GROUP #
NMD78526Medicare UPIN
NML9727Medicaid
349419402Medicare PIN