Basic Information
| Provider Information | |||||||||
| NPI: | 1972532356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITTEN-STOVALL | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 PAGE ST | ||||||||
| Address2: | SNEPA | ||||||||
| City: | NEW BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027403464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089615930 | ||||||||
| FaxNumber: | 5089615931 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 PAGE ST | ||||||||
| Address2: | SNEPA | ||||||||
| City: | NEW BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027403464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089615930 | ||||||||
| FaxNumber: | 5089615931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 160584 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 8897 | ND | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 2114810 | 05 | MA | MEDICAID |