Provider Demographics
NPI:1760461180
Name:WHITLARK, JOSEPH D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:WHITLARK
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 1:905 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6626
Mailing Address - Country:US
Mailing Address - Phone:814-238-8418
Mailing Address - Fax:814-234-2888
Practice Address - Street 1:905 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6626
Practice Address - Country:US
Practice Address - Phone:814-238-8418
Practice Address - Fax:814-234-2888
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000722778208600000X, 2086S0129X, 208G00000X
225100000X, 2471V0105X
PAMD039559E208G00000X, 2086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12953OtherBLUE CROSS
NC8912953Medicaid
NC2293437AOtherMEDICARE ID
NC12953OtherBLUE CROSS
NC2293437AOtherMEDICARE ID