Provider Demographics
NPI:1689662355
Name:WHALEY, DONALD R (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:WHALEY
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 1:760 OAKRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2324
Mailing Address - Country:US
Mailing Address - Phone:910-738-7857
Mailing Address - Fax:910-739-3705
Practice Address - Street 1:760 OAKRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2324
Practice Address - Country:US
Practice Address - Phone:910-738-7857
Practice Address - Fax:910-739-3705
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300371207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8986704Medicaid
NC86704OtherBLUE CROSS BLUE SHIELD
NC86704OtherBLUE CROSS BLUE SHIELD
E42766Medicare UPIN
NC2188689Medicare PIN