Provider Demographics
NPI:1154499093
Name:WHITELEY, REBECCA D (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:WHITELEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:D
Other - Last Name:WHITELEY-PEELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:195 FORE RIVER PKWY
Mailing Address - Street 2:STE 440
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-553-6920
Mailing Address - Fax:207-553-6940
Practice Address - Street 1:195 FORE RIVER PKWY
Practice Address - Street 2:SUITE 440
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-553-6920
Practice Address - Fax:207-553-6940
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017407174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432509399Medicaid
ME432509399Medicaid
ME000137401Medicare PIN