Provider Demographics
NPI:1447242698
Name:WHALEN, RALPH CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:CHARLES
Last Name:WHALEN
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 1:2109 HUGHES DR
Mailing Address - Street 2:#450
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3856
Mailing Address - Country:US
Mailing Address - Phone:419-291-2003
Mailing Address - Fax:419-479-6977
Practice Address - Street 1:2109 HUGHES DR
Practice Address - Street 2:#450
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3856
Practice Address - Country:US
Practice Address - Phone:419-291-2003
Practice Address - Fax:419-479-6977
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-5931-W2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0303442Medicaid
A75077Medicare UPIN
OH0303442Medicaid
MIM72020002Medicare PIN