Provider Demographics
NPI:1457336299
Name:WHELAN, DEBORAH MOSCAL (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MOSCAL
Last Name:WHELAN
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:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-8190
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-716-8190
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34768207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
63981OtherMEDCOST
4665726OtherAETNA
8879OtherPARTNERS
NC8986812Medicaid
WV208507000Medicaid
86812OtherBCBS
SCQ34769Medicaid
50086498OtherRR MEDICARE
VA5701597Medicaid
63981OtherMEDCOST