Provider Demographics
NPI:1609405315
Name:WHALEN, CARL T
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:T
Last Name:WHALEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1654
Mailing Address - Country:US
Mailing Address - Phone:505-916-6544
Mailing Address - Fax:505-205-1514
Practice Address - Street 1:3121 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1654
Practice Address - Country:US
Practice Address - Phone:505-228-2108
Practice Address - Fax:505-205-1514
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-04
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDO2024-00962083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine