Individual
MR. MICHAEL ELLIOT WHALEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
164 SUMMIT AVE, PROVIDENCE, RI 02906-2853
(401) 793-4102
(401) 793-4049
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4541
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01153
RI
363A00000X
Physician Assistant
PA5543
MA
Other
Enumeration date
10/21/2015
Last updated
03/25/2024
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