Provider Demographics
NPI:1821098229
Name:WHITLOCK, DUANE M (MD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:M
Last Name:WHITLOCK
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 1:455 S WASHINGTON ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-2516
Mailing Address - Country:US
Mailing Address - Phone:717-334-9159
Mailing Address - Fax:334-359-7225
Practice Address - Street 1:455 S WASHINGTON ST
Practice Address - Street 2:SUITE 24
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2516
Practice Address - Country:US
Practice Address - Phone:717-334-9159
Practice Address - Fax:334-359-7225
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418674174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH90255Medicare UPIN