Provider Demographics
NPI:1659330397
Name:WHITMAN, ANGELA DARLENE (DO)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DARLENE
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MACCORKLE AVE SE STE 700
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1230
Mailing Address - Country:US
Mailing Address - Phone:304-720-7305
Mailing Address - Fax:304-720-7310
Practice Address - Street 1:3100 MACCORKLE AVE SE STE 700
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1230
Practice Address - Country:US
Practice Address - Phone:304-720-7305
Practice Address - Fax:304-720-7310
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1659330397Medicaid
WV3810008840Medicaid
WV3810024049OtherGROUP MEDICAID
WVB441OtherGROUP MEDICARE
WV1659330397Medicaid
KY0364970Medicare ID - Type Unspecified
I37577Medicare UPIN
WV4211701Medicare PIN