Provider Demographics
NPI:1528405719
Name:WHITTEN, CHARLES WESTON (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WESTON
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 1:4546 S 86TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9252
Mailing Address - Country:US
Mailing Address - Phone:402-488-7246
Mailing Address - Fax:402-488-7247
Practice Address - Street 1:4546 S 86TH ST STE B
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526
Practice Address - Country:US
Practice Address - Phone:402-488-7246
Practice Address - Fax:402-488-7247
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
NE30483207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program