Provider Demographics
NPI:1720043227
Name:WHELAN, THOMAS PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
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 1:2 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2100
Mailing Address - Country:US
Mailing Address - Phone:203-791-2221
Mailing Address - Fax:203-791-0682
Practice Address - Street 1:2 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2100
Practice Address - Country:US
Practice Address - Phone:203-791-2221
Practice Address - Fax:203-791-0682
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029121207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001291210Medicaid
CT001291210Medicaid
1001291210Medicare ID - Type Unspecified