Basic Information
Provider Information | |||||||||
NPI: | 1881034908 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WHITTAKER | ||||||||
FirstName: | NAOMI | ||||||||
MiddleName: | MIRIAM | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SASIN | ||||||||
OtherFirstName: | NAOMI | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1824 GOOD HOPE RD | ||||||||
Address2: |   | ||||||||
City: | ENOLA | ||||||||
State: | PA | ||||||||
PostalCode: | 170251233 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7179889015 | ||||||||
FaxNumber: | 7172215410 | ||||||||
Practice Location | |||||||||
Address1: | 1824 GOOD HOPE RD | ||||||||
Address2: |   | ||||||||
City: | ENOLA | ||||||||
State: | PA | ||||||||
PostalCode: | 170251233 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7179889015 | ||||||||
FaxNumber: | 7172215410 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/03/2013 | ||||||||
LastUpdateDate: | 01/07/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/07/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 125.063321 | IL | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 207V00000X | MD465079 | PA | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | 1035401710001 | 05 | PA |   | MEDICAID |