Provider Demographics
NPI:1053363317
Name:WHELAN, CHRIS MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:MICHAEL
Last Name:WHELAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188
Mailing Address - Country:US
Mailing Address - Phone:781-626-5160
Mailing Address - Fax:781-803-2645
Practice Address - Street 1:330 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188
Practice Address - Country:US
Practice Address - Phone:781-626-5160
Practice Address - Fax:781-803-2645
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78920207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ19793OtherBLUE SHIELD
MA3190340Medicaid
MAJ19793OtherBLUE SHIELD
MATX0343Medicare PIN
MA930107490Medicare PIN
MAF81863Medicare UPIN