Provider Demographics
NPI:1437143302
Name:WHELAN, JOSEPH G JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:G
Last Name:WHELAN
Suffix:JR
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 1:3030 LATROBE DRIVE
Mailing Address - Street 2:CHARLOTTE RADIOLOGY
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4866
Mailing Address - Country:US
Mailing Address - Phone:704-362-1945
Mailing Address - Fax:704-770-0501
Practice Address - Street 1:3030 LATROBE DRIVE
Practice Address - Street 2:CHARLOTTE RADIOLOGY
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4866
Practice Address - Country:US
Practice Address - Phone:704-362-1945
Practice Address - Fax:704-770-0501
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC324512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8986734Medicaid
SCN32451Medicaid
NCC74022Medicare UPIN
NC8986734Medicaid