Provider Demographics
NPI:1912986951
Name:WHERLEY, ANDREW JACK (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JACK
Last Name:WHERLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2027
Mailing Address - Country:US
Mailing Address - Phone:330-343-3213
Mailing Address - Fax:330-364-2729
Practice Address - Street 1:658 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2027
Practice Address - Country:US
Practice Address - Phone:330-343-3213
Practice Address - Fax:330-364-2729
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064274W207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2055672Medicaid
OH2055672Medicaid
WH0847103Medicare ID - Type Unspecified