Basic Information
| Provider Information | |||||||||
| NPI: | 1689634529 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHITNEY PEDIATRICS & ADOLESCENT MEDICINE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 WHITNEY AVE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032875400 | ||||||||
| FaxNumber: | 2032813001 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 WHITNEY AVE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032875400 | ||||||||
| FaxNumber: | 2032813001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2032875400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No ID Information.