Provider Demographics
NPI:1356317291
Name:WHITNEY, MARILYN V (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:V
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HILLCREST CT
Mailing Address - Street 2:
Mailing Address - City:OSSIAN
Mailing Address - State:IN
Mailing Address - Zip Code:46777-9053
Mailing Address - Country:US
Mailing Address - Phone:260-622-4707
Mailing Address - Fax:260-622-4617
Practice Address - Street 1:105 HILLCREST CT
Practice Address - Street 2:
Practice Address - City:OSSIAN
Practice Address - State:IN
Practice Address - Zip Code:46777-9053
Practice Address - Country:US
Practice Address - Phone:260-622-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100468350XMedicaid
IN100468350AMedicaid
IN100468350Medicaid
IN000000614630OtherANTHEM
IN000000614630OtherANTHEM
IN100468350Medicaid