Provider Demographics
NPI:1700843364
Name:WHITEMAN, ROY DAVID RUSSELL JR (MBA PT)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:DAVID RUSSELL
Last Name:WHITEMAN
Suffix:JR
Gender:M
Credentials:MBA PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11801 INDUSTRIAL PARK
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-5139
Mailing Address - Country:US
Mailing Address - Phone:301-729-3485
Mailing Address - Fax:301-729-0158
Practice Address - Street 1:11801 INDUSTRIAL PARK
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-5139
Practice Address - Country:US
Practice Address - Phone:301-729-3485
Practice Address - Fax:301-729-0158
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15914225100000X
WV634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0003OtherCAREFIRST BCBS OF DC NCA
WV0157289000Medicaid
222839OtherMAMSI
MD40024504OtherBLUE CROSS BLUE SHIELD
WV1017320OtherWORKERS COMPENSATION
7555296OtherAETNA
222839OtherMAMSI