Provider Demographics
NPI:1508849381
Name:WHATLEY, RALPH E III (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:E
Last Name:WHATLEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 BELLEVIEW AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1838
Mailing Address - Country:US
Mailing Address - Phone:540-981-7000
Mailing Address - Fax:540-983-1133
Practice Address - Street 1:1906 BELLEVIEW AVE SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1838
Practice Address - Country:US
Practice Address - Phone:540-981-7000
Practice Address - Fax:540-983-1133
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501454207RP1001X
VA0101-242430207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC290009164OtherRAILROAD MEDICARE
VA1508849381Medicaid
NC8986712Medicaid
NC86712OtherBCBS NC
NC8986712Medicaid
VA015218C19Medicare PIN
VA1508849381Medicaid
NC2215390Medicare ID - Type Unspecified