Provider Demographics
NPI:1710980214
Name:WHALEY, MARC A, (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A,
Last Name:WHALEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:85 HERRICK ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1790
Mailing Address - Country:US
Mailing Address - Phone:978-816-3700
Mailing Address - Fax:978-524-6028
Practice Address - Street 1:85 HERRICK ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1777
Practice Address - Country:US
Practice Address - Phone:978-816-3700
Practice Address - Fax:978-524-6028
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA345062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2016664Medicaid
B97305Medicare UPIN
MAC26027Medicare ID - Type Unspecified