Provider Demographics
NPI:1518056472
Name:WHITTEN, THOMAS LYNN (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LYNN
Last Name:WHITTEN
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 1:4893 STATE ROUTE 30
Mailing Address - Street 2:SUITE8
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6494
Mailing Address - Country:US
Mailing Address - Phone:724-600-0607
Mailing Address - Fax:724-600-0608
Practice Address - Street 1:4893 STATE ROUTE 30
Practice Address - Street 2:SUITE8
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6494
Practice Address - Country:US
Practice Address - Phone:724-600-0607
Practice Address - Fax:724-600-0608
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA038465E208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1200552Medicaid
PAWH022035Medicare ID - Type Unspecified
PA1200552Medicaid