Provider Demographics
NPI:1881034908
Name:WHITTAKER, NAOMI MIRIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:MIRIAM
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:
Other - Last Name:SASIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1824 GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1233
Mailing Address - Country:US
Mailing Address - Phone:717-988-9015
Mailing Address - Fax:717-221-5410
Practice Address - Street 1:1824 GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1233
Practice Address - Country:US
Practice Address - Phone:717-988-9015
Practice Address - Fax:717-221-5410
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.063321207V00000X
PAMD465079207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035401710001Medicaid