Provider Demographics
NPI:1982695839
Name:WHITMORE, METIVIA-ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:METIVIA-ANNE
Middle Name:
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:METIVIA-ANNE
Other - Middle Name:
Other - Last Name:BERKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:31 SHERMAN AVE
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701
Mailing Address - Country:US
Mailing Address - Phone:716-338-9797
Mailing Address - Fax:716-338-1567
Practice Address - Street 1:31 SHERMAN AVE
Practice Address - Street 2:SUITE 2200
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2514
Practice Address - Country:US
Practice Address - Phone:716-383-3797
Practice Address - Fax:716-753-5367
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301782207Q00000X
NY011192-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA172630Medicare ID - Type Unspecified
Q09228Medicare UPIN