Provider Demographics
NPI:1891863437
Name:WHALEN, RICHARD PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PAUL
Last Name:WHALEN
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 1:54 TAYLOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 HEALTH LANE
Practice Address - Street 2:THE KENT CENTER FOR HUMAN & ORGANIZATIONAL DEVELOPMENT
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-738-4300
Practice Address - Fax:401-738-7718
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD93802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7005743Medicaid
RI1553662OtherUBH
RI400987OtherBLUE CHIP
RI301369OtherBLUE CROSS
RI1553662OtherUBH
RI7005743Medicaid