Basic Information
Provider Information | |||||||||
NPI: | 1558328898 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WHITCOMB | ||||||||
FirstName: | WINTHROP | ||||||||
MiddleName: | F | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 145 VERNON ST | ||||||||
Address2: |   | ||||||||
City: | NORTHAMPTON | ||||||||
State: | MA | ||||||||
PostalCode: | 010602818 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4133358684 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 548 ELM ST | ||||||||
Address2: |   | ||||||||
City: | NORTHAMPTON | ||||||||
State: | MA | ||||||||
PostalCode: | 010602832 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4137948120 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/28/2006 | ||||||||
LastUpdateDate: | 04/15/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 73170 | MA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 73170 | MA | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 3114198 | 05 | MA |   | MEDICAID | 003119171 | 05 | CT |   | MEDICAID | 01914034 | 05 | NY |   | MEDICAID |