Provider Demographics
NPI:1720033954
Name:WHITMOYER, STEPHEN R (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:WHITMOYER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:FOURTH AND WALNUT STREETS
Mailing Address - Street 2:ATTN: RADIOLOGY DEPARTMENT
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-1281
Mailing Address - Country:US
Mailing Address - Phone:717-270-7645
Mailing Address - Fax:717-270-7596
Practice Address - Street 1:FOURTH AND WALNUT STREETS
Practice Address - Street 2:ATTN: RADIOLOGY DEPARTMENT
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-1281
Practice Address - Country:US
Practice Address - Phone:717-270-7645
Practice Address - Fax:717-270-7596
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-03-02
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Provider Licenses
StateLicense IDTaxonomies
PAMD051390L2085R0202X, 2085R0204X, 2085N0904X, 2085R0204X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001708351Medicaid
PA001708351Medicaid
PA001708351Medicaid