Doctor Name: | NELLIE LAVERN WHITAKER |
NPI Number: | 1326124595 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | D0028436 |
Business Practice Address: | 1667 Croftoncentre Suite 1 Crofton, MD - 21114 |
Business Phone Number: | 4107212700 |
Business Fax Number: | 4107218874 |
Mailing Address: | 1667 Croftoncentre, Suite 1 CROFTON |
State: | MD |
Postal Code: | 21114 |
Phone Number: | 4107212700 |
Fax Number: | 4107218874 |
NPI Enumeration Date: | 10/31/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | D0028436 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |