Provider Demographics
NPI:1285638866
Name:WHITAKER, ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:
Last Name:WHITAKER
Suffix:
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:PO BOX 38157
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27438-8157
Mailing Address - Country:US
Mailing Address - Phone:336-282-5000
Mailing Address - Fax:336-482-3778
Practice Address - Street 1:3312 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2402
Practice Address - Country:US
Practice Address - Phone:336-282-5000
Practice Address - Fax:336-482-3778
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26482207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC180045160OtherRR MEDICARE PROVIDER #
NC89112204Medicaid
VA010000530OtherVA MEDICAID PROVIDER #
NC256849OtherMAMSI
NC34363OtherPARTNERS PROVIDER #
NC4671676OtherAETNA PROVIDER #
NC561783008OtherTAX IDENTIFICATION #
NC12204OtherBCBS PROVIDER #
VA277270OtherANTHEM BCBS PROVIDER #
NCB8181OtherMEDCOST
NC24168OtherOPTICARE PROVIDER #
VA010000530OtherVA MEDICAID PROVIDER #
NC2275873Medicare PIN
NC24168OtherOPTICARE PROVIDER #