Provider Demographics
NPI:1376501056
Name:WHALEN, JASON GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:GEORGE
Last Name:WHALEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:160 MILLERS RUN RD STE 500
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1358
Mailing Address - Country:US
Mailing Address - Phone:412-564-5444
Mailing Address - Fax:412-564-5478
Practice Address - Street 1:160 MILLERS RUN RD STE 500
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1358
Practice Address - Country:US
Practice Address - Phone:412-564-5444
Practice Address - Fax:412-564-5478
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428164207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD428164OtherMEDICAL LICENSE
PAMD428164OtherMEDICAL LICENSE