Provider Demographics
NPI:1386637411
Name:WHALEN, MICHAEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:WHALEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1375 WASHINGTON AVE
Mailing Address - Street 2:SUITE227
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1070
Mailing Address - Country:US
Mailing Address - Phone:518-465-7172
Mailing Address - Fax:518-465-7177
Practice Address - Street 1:1375 WASHINGTON AVE
Practice Address - Street 2:SUITE 227
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206
Practice Address - Country:US
Practice Address - Phone:518-465-7172
Practice Address - Fax:518-465-7177
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2008-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY102495207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0248Medicare PIN
NYB77526Medicare UPIN