Provider Demographics
NPI:1689767212
Name:WHELAN, TIMOTHY PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:WHELAN
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:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8908
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:843-792-1729
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46312207RP1001X
SCTL 32438207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0064770Medicaid
MN514140100Medicaid
IA0569293Medicaid
ND10387Medicaid
SD7777470Medicaid
MN171900OtherUCARE
MN1034609OtherPREFERREDONE
MN1936677OtherARAZ
WI34428700Medicaid
MN637140OtherFAIRVIEW
MN48-00307OtherMEDICA - CHOICE
MNHP40916OtherHEALTHPARTNERS
MN48-00306OtherMEDICA - PRIMARY
SD7777470Medicaid