Provider Demographics
NPI:1619273042
Name:WHELAN, TARA (DO)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:WHELAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BOOMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-1012
Mailing Address - Country:US
Mailing Address - Phone:401-575-7113
Mailing Address - Fax:
Practice Address - Street 1:45 WELLS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2961
Practice Address - Country:US
Practice Address - Phone:401-315-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00708207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology