Basic Information
| Provider Information | |||||||||
| NPI: | 1992987622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITMORE | ||||||||
| FirstName: | L. | ||||||||
| MiddleName: | TIMOTHY | ||||||||
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| Credential: | PHYSICIAN ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237033205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574836404 | ||||||||
| FaxNumber: | 7574830737 | ||||||||
| Practice Location | |||||||||
| Address1: | 3636 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237073236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7573982383 | ||||||||
| FaxNumber: | 7573982396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2007 | ||||||||
| LastUpdateDate: | 03/08/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 0110000024 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.