Individual
DR. IAN RALPH WHITESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 BELLE TERRE RD, PORT JEFFERSON, NY 11777-1968
(631) 474-6000
Mailing address
2330 UTAH AVE STE 200, EL SEGUNDO, CA 90245-4817
(424) 290-8004
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
303407
NY
2085U0001X
Diagnostic Ultrasound Physician
303407
NY
Other
Enumeration date
05/13/2014
Last updated
07/24/2021
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