Provider Demographics
NPI:1831194356
Name:WHALLEY, JOHN FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:WHALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 MEDICAL HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5197
Mailing Address - Country:US
Mailing Address - Phone:828-433-4484
Mailing Address - Fax:828-433-4487
Practice Address - Street 1:100 MEDICAL HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5197
Practice Address - Country:US
Practice Address - Phone:828-433-4484
Practice Address - Fax:828-433-4487
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC18743208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12 60014OtherUNITED HEALTHCARE
NC32550OtherMEDCOST
NC4455597OtherAETNA
NC8986692Medicaid
NC86692OtherBCBS OF NC
NCC81358Medicare UPIN
NC4455597OtherAETNA