Individual
DR. KENNETH WHITTEMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 LONGWOOD AVE, LO-367, BOSTON, MA 02115-5724
(617) 355-6417
(617) 730-0611
Mailing address
PO BOX 844058, BOSTON, MA 02284-4058
(617) 355-6417
(617) 730-0611
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
213533
MA
207Y00000X
Otolaryngology Physician
227868
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
699582
GHI
NY
01
—
7434384
AETNA
NY
01
—
P00010004
RAIL ROAD MEDICARE
NY
Enumeration date
07/07/2006
Last updated
07/23/2007
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