Basic Information
| Provider Information | |||||||||
| NPI: | 1811958648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITEHEAD | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 199 REEDSDALE ROAD | ||||||||
| Address2: | DEPT OF DIAGNOSTIC IMAGING, MILTON HOSPITAL | ||||||||
| City: | MILTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176964600 | ||||||||
| FaxNumber: | 6173131526 | ||||||||
| Practice Location | |||||||||
| Address1: | 199 REEDSDALE ROAD | ||||||||
| Address2: | DEPT OF DIAGNOSTIC IMAGING, MILTON HOSPITAL | ||||||||
| City: | MILTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176964600 | ||||||||
| FaxNumber: | 6173131526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 151717 | MA | X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | 151717 | MA | X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3164764 | 05 | MA | MEDICAID |