Basic Information
Provider Information | |||||||||
NPI: | 1912962986 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WHITMAN | ||||||||
FirstName: | SCOTT | ||||||||
MiddleName: | ERIC | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPM | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3800 HIGHWAY 49 S | ||||||||
Address2: |   | ||||||||
City: | HARRISBURG | ||||||||
State: | NC | ||||||||
PostalCode: | 280757522 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7044552999 | ||||||||
FaxNumber: | 7044551624 | ||||||||
Practice Location | |||||||||
Address1: | 3800 HIGHWAY 49 S | ||||||||
Address2: |   | ||||||||
City: | HARRISBURG | ||||||||
State: | NC | ||||||||
PostalCode: | 280757522 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7044552999 | ||||||||
FaxNumber: | 7044551624 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/20/2006 | ||||||||
LastUpdateDate: | 08/16/2011 | ||||||||
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 | 213E00000X | N005815 | NY | Y |   | Podiatric Medicine & Surgery Service Providers | Podiatrist |   | 213ES0103X | 523 | NC | N |   | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.