Provider Demographics
NPI:1235231994
Name:WHITAKER, ANTHONY REGINALD (MD,JD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:REGINALD
Last Name:WHITAKER
Suffix:
Gender:M
Credentials:MD,JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4832 BRANTFORD CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-5502
Mailing Address - Country:US
Mailing Address - Phone:513-942-3644
Mailing Address - Fax:
Practice Address - Street 1:4832 BRANTFORD CT
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5502
Practice Address - Country:US
Practice Address - Phone:513-942-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-0855502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2546123Medicaid
OH2546123Medicaid