Provider Demographics
NPI:1164587697
Name:WHALEN, THOMAS J (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:WHALEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:117 N EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3435
Mailing Address - Country:US
Mailing Address - Phone:610-446-4409
Mailing Address - Fax:610-446-4151
Practice Address - Street 1:117 N EAGLE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3435
Practice Address - Country:US
Practice Address - Phone:610-446-4409
Practice Address - Fax:610-446-4151
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004351L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232669309OtherTAX ID
PAC27232Medicare UPIN
PA441000Medicare ID - Type Unspecified