Provider Demographics
NPI:1538143862
Name:WHITAKER, DONALD R (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:WHITAKER
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 1:83 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2478
Mailing Address - Country:US
Mailing Address - Phone:914-964-4333
Mailing Address - Fax:914-964-4767
Practice Address - Street 1:967 N BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1301
Practice Address - Country:US
Practice Address - Phone:914-964-4330
Practice Address - Fax:914-964-4767
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1676712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01086882Medicaid
NYA61511Medicare UPIN
NY01086882Medicaid