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Provider Information for 1124026398

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Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DIANE L WHITAKER MD

Gender: FEMALE

Individual NPI: 1124026398

Calendar   Last Updated:  2012-06-15
  Certification Date: 

Details

Name Value
NPI 1124026398
Enumeration Date 2005-07-12
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 263 FARMINGTON AVE PROVIDER ENROLLMENT
FARMINGTON, CT 06030-2212
United States

Phone: 860-679-7503 | Fax: 860-679-1610
View Map External Link
Primary Practice Address 263 FARMINGTON AVE
FARMINGTON, CT 06030-0001
United States

Phone: 860-679-4600 | Fax: 860-679-1248
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID CT 1323831
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207N00000X - Dermatology CT 032383