Provider Demographics
NPI:1134322514
Name:WHETSTONE, RODNEY THOMAS (CRNA)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:THOMAS
Last Name:WHETSTONE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 TULLS HILL RD
Mailing Address - Street 2:
Mailing Address - City:MANNS CHOICE
Mailing Address - State:PA
Mailing Address - Zip Code:15550-8734
Mailing Address - Country:US
Mailing Address - Phone:301-723-4965
Mailing Address - Fax:301-723-4983
Practice Address - Street 1:115 BALTIMORE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2301
Practice Address - Country:US
Practice Address - Phone:301-723-4965
Practice Address - Fax:301-723-4983
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2014-05-06
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-06
Provider Licenses
StateLicense IDTaxonomies
MDR070522367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD187910300Medicaid
WV0067808000Medicaid
MD187910300Medicaid