Provider Demographics
NPI:1750550927
Name:DONALD R. WHALEY, M.D. PC
Entity type:Organization
Organization Name:DONALD R. WHALEY, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-738-7857
Mailing Address - Street 1:760 OAKRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2324
Mailing Address - Country:US
Mailing Address - Phone:910-738-7857
Mailing Address - Fax:910-739-3705
Practice Address - Street 1:760 OAKRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2324
Practice Address - Country:US
Practice Address - Phone:910-738-7857
Practice Address - Fax:910-739-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300371207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8986704Medicaid
NC8986704Medicaid
NC2188689Medicare PIN
NC1256580001Medicare NSC