Provider Demographics
NPI:1942455589
Name:WHITTEMORE, KERRY E (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:E
Last Name:WHITTEMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4526
Mailing Address - Country:US
Mailing Address - Phone:518-798-9985
Mailing Address - Fax:
Practice Address - Street 1:154 WARREN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4526
Practice Address - Country:US
Practice Address - Phone:518-798-9985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7470006-1205208000000X
NY263814208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03418802Medicaid