Provider Demographics
NPI:1407843956
Name:WHITLEY, KARL (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:WHITLEY
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 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:3/208N
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-3663
Mailing Address - Fax:215-707-7523
Practice Address - Street 1:3509 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19140-4105
Practice Address - Country:US
Practice Address - Phone:215-707-3663
Practice Address - Fax:215-226-8286
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049534L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001560548Medicaid
PA5558502OtherAETNA PPO
PAP00313454OtherRAILROAD MEDICARE
PA562290OtherHIGHMARK BLUE SHIELD
PA0745640000OtherINDEPENDENCE BLUE CROSS
PA519043OtherCOVENTRY HEALTH AMERICA
PA17012OtherBRAVO HEALTH
PA30011554OtherKEYSTONE MERCY HEALTH
PA5558502OtherAETNA PPO
PA519043OtherCOVENTRY HEALTH AMERICA
PA30011554OtherKEYSTONE MERCY HEALTH