Provider Demographics
NPI:1891795498
Name:WHALEN, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:WHALEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4007 WILD NURSERY CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-5345
Mailing Address - Country:US
Mailing Address - Phone:704-616-7387
Mailing Address - Fax:704-834-2815
Practice Address - Street 1:2525 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2140
Practice Address - Country:US
Practice Address - Phone:704-834-2851
Practice Address - Fax:704-834-2815
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2012-01-03
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Provider Licenses
StateLicense IDTaxonomies
NC95-01148207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG-48717Medicare UPIN
NC2237345BMedicare PIN