Provider Demographics
NPI:1689876559
Name:WHITNEY, MARY CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CHRISTINE
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2745
Mailing Address - Country:US
Mailing Address - Phone:719-584-4306
Mailing Address - Fax:719-584-4861
Practice Address - Street 1:400 W 16TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2745
Practice Address - Country:US
Practice Address - Phone:719-584-4306
Practice Address - Fax:719-584-4861
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065579A207P00000X
CODR.0050033207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200987460AMedicaid
INP00852082OtherRAILROAD MEDICARE
CO83401563Medicaid
INP00837117OtherRAILROAD MEDICARE
IN000000659993OtherANTHEM BC/BS
IN000000670714OtherANTHEM BC/BS
INM400017238Medicare PIN
INM400020698Medicare PIN
IN000000659993OtherANTHEM BC/BS