Provider Demographics
NPI:1003881483
Name:WHALEN, RICHARD M (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5955
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5955
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-002OtherTRICARE/CHAMPUS
VA426444OtherANTHEM BC/BS
VAPAROtherAETNA
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherVIRGINA PREMIER HEALTH PLAN
NC5917806Medicaid
VAPAROtherMULTIPLAN
VAPAROtherUSA MANAGED CARE
VA1003881483Medicaid
VA426447OtherANTHEM BC/BS
VAPAROtherCORVEL
VA78535OtherOPTIMA HEALTH
VAPAROtherCIGNA
VAPAROtherFIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH
VAPAROtherUNITED HEALTHCARE/MAMSI
VA426444OtherANTHEM BC/BS
VA1003881483Medicaid