Individual
IAN ERIC WHITTALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(203) 584-1576
Mailing address
1324 FRANKFORD AVE, PHILADELPHIA, PA 19125-3204
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MT227241
PA
Other
Enumeration date
06/17/2022
Last updated
06/17/2022
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