Individual
CHARLES J WHALEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2514 E DUPONT RD, FORT WAYNE, IN 46825-1623
(260) 484-8830
Mailing address
2514 E DUPONT RD STE 100, FORT WAYNE, IN 46825-1619
(260) 484-8830
(260) 483-1911
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
01051941A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000111208
ANTHEM
IN
01
—
000000693552
ANTHEM
IN
05
—
200250710
—
IN
05
—
3045565
—
OH
Enumeration date
08/10/2005
Last updated
05/06/2020
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