Provider Demographics
NPI:1629065396
Name:WHITNEY, RICHARD W (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:541 MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1868
Mailing Address - Country:US
Mailing Address - Phone:781-952-1200
Mailing Address - Fax:781-340-1610
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1868
Practice Address - Country:US
Practice Address - Phone:781-952-1200
Practice Address - Fax:781-340-1610
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA38624207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA40154OtherFALLON COMM HEALTH PLAN
MAC27085OtherBLUE CROSS
MA0036426OtherNEIGHBORHOOD HEALTH PLAN
MA2072505Medicaid
MA703697OtherTUFTS
MA3019OtherHARVARD PILGRIM
MAC27085OtherBLUE CROSS
MA0036426OtherNEIGHBORHOOD HEALTH PLAN
B97327Medicare UPIN