Provider Demographics
NPI:1821232398
Name:WHITING, GENEVIEVE S (MD)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:S
Last Name:WHITING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:S
Other - Last Name:LONDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:190 RIVERSIDE ST
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1073
Mailing Address - Country:US
Mailing Address - Phone:207-661-2000
Mailing Address - Fax:
Practice Address - Street 1:1 HARNOIS AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4392
Practice Address - Country:US
Practice Address - Phone:207-662-1360
Practice Address - Fax:207-662-1361
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-02185208000000X
MEMD19673208000000X
NY259174208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1821232398Medicaid
ME1821232398Medicaid
MEE400226252Medicare PIN