Provider Demographics
NPI:1972532356
Name:WHITTEN-STOVALL, RICHARD F (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:WHITTEN-STOVALL
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 1:101 PAGE ST
Mailing Address - Street 2:SNEPA
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-3464
Mailing Address - Country:US
Mailing Address - Phone:508-961-5930
Mailing Address - Fax:508-961-5931
Practice Address - Street 1:101 PAGE ST
Practice Address - Street 2:SNEPA
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3464
Practice Address - Country:US
Practice Address - Phone:508-961-5930
Practice Address - Fax:508-961-5931
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1605842084P0800X
ND88972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2114810Medicaid
MAA36837Medicare ID - Type Unspecified
MA2114810Medicaid