Provider Demographics
NPI:1780681064
Name:WHALEN, JAMES D (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:WHALEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 WILLOWBROOK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-1745
Mailing Address - Country:US
Mailing Address - Phone:860-322-2222
Mailing Address - Fax:860-322-6838
Practice Address - Street 1:1 WILLOWBROOK RD STE 2
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416
Practice Address - Country:US
Practice Address - Phone:860-322-2222
Practice Address - Fax:860-322-6838
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT033745207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1337452Medicaid
CTF55301Medicare UPIN
CT1337452Medicaid