Provider Demographics
NPI:1447247630
Name:WHITLOCK, JAMES A (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:WHITLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:354 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1754
Mailing Address - Country:US
Mailing Address - Phone:978-687-2321
Mailing Address - Fax:978-685-7265
Practice Address - Street 1:70 BUTLER ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3925
Practice Address - Country:US
Practice Address - Phone:603-893-2900
Practice Address - Fax:603-898-4361
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA513562084N0400X
NH75942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0003764OtherNHP
MAJ06269OtherBCBS
NH0102770Y0NH01OtherANTHEM
MA4373143OtherAETNA
MA715273OtherTHP
MA05-00412OtherEVERCARE
MA11781OtherHPHC
MA1313662-001OtherCIGNA
MA23599OtherFCHP
MA05-00076OtherUHC
MA3023192Medicaid
NH30002080Medicaid
B76242Medicare UPIN
B76242Medicare UPIN
MA0003764OtherNHP