Provider Demographics
NPI:1700873031
Name:THE WHALEN CLINIC
Entity Type:Organization
Organization Name:THE WHALEN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:F
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-255-8658
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-0122
Mailing Address - Country:US
Mailing Address - Phone:207-255-8658
Mailing Address - Fax:207-255-0711
Practice Address - Street 1:46 CENTER ST
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-0122
Practice Address - Country:US
Practice Address - Phone:207-255-8658
Practice Address - Fax:207-255-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4951470001OtherDMERC
DA6405OtherRAILROAD MEDICARE
ME0145Medicare ID - Type Unspecified