Provider Demographics
NPI:1467517243
Name:ELIZABETH A WHALEN MD LLC
Entity Type:Organization
Organization Name:ELIZABETH A WHALEN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, ELIZABETH A. WHALEN, MD, LL
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-489-6718
Mailing Address - Street 1:PO BOX 150473
Mailing Address - Street 2:DEPT. 445
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06115-0473
Mailing Address - Country:US
Mailing Address - Phone:860-489-6718
Mailing Address - Fax:860-489-8270
Practice Address - Street 1:200 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3096
Practice Address - Country:US
Practice Address - Phone:860-489-6718
Practice Address - Fax:860-489-8270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0327712085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00132771800OtherBLUECARE FAMILY PLAN
P3016477OtherOXFORD HEALTH PLANS
759274OtherCONNECTICARE
CT010032771CT03OtherANTHEM
272652OtherPREFERRED ONE
F55901Medicare UPIN