Provider Demographics
NPI:1013912351
Name:WHITNEY, TIMOTHY M (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:WHITNEY
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 1:2500 SQUALICUM PKWY BLDG 102
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1856
Mailing Address - Country:US
Mailing Address - Phone:360-676-0972
Mailing Address - Fax:360-671-4423
Practice Address - Street 1:2500 SQUALICUM PKWY BLDG 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1856
Practice Address - Country:US
Practice Address - Phone:360-676-0972
Practice Address - Fax:360-671-4423
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042035174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8371155Medicaid
WA8371155Medicaid
WAGAB38790Medicare ID - Type Unspecified