Provider Demographics
NPI:1649211780
Name:WHITMORE, WAYNE GRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:GRAHAM
Last Name:WHITMORE
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 1:116 E 68TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5955
Mailing Address - Country:US
Mailing Address - Phone:212-249-3030
Mailing Address - Fax:212-988-4140
Practice Address - Street 1:116 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5955
Practice Address - Country:US
Practice Address - Phone:212-249-3030
Practice Address - Fax:212-988-4140
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134848207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00594234Medicaid
NY00594234Medicaid
NYB15162Medicare UPIN