Provider Demographics
NPI:1477545952
Name:WHALEN, ANNE B (DO)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:B
Last Name:WHALEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SCOTCH RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2512
Mailing Address - Country:US
Mailing Address - Phone:609-883-5454
Mailing Address - Fax:
Practice Address - Street 1:51 SCOTCH RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-2512
Practice Address - Country:US
Practice Address - Phone:609-883-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 008612 L207Q00000X
PAOS008612L207QG0300X
NJ25MB12173300207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1482983OtherCIGNA PA
PA0400375000OtherKEYSTONE IBC
PA30087554OtherKEYSTONE FIRST
PA0017082710006Medicaid
PA5905575OtherAETNA
PA01708271Medicaid
PA951546OtherHIGHMARK BLUE SHIELD
PAP00926825OtherRAILROAD MEDICARE
PA30087554OtherKEYSTONE FIRST
PA0400375000OtherKEYSTONE IBC