Provider Demographics
NPI:1487760948
Name:WHITTEMORE, JENNIFER L (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:WHITTEMORE
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 1:1450 WESTERN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3539
Mailing Address - Country:US
Mailing Address - Phone:516-463-0050
Mailing Address - Fax:518-207-2973
Practice Address - Street 1:1450 WESTERN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3539
Practice Address - Country:US
Practice Address - Phone:516-463-0050
Practice Address - Fax:518-207-2973
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY239310-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RB1787Medicare PIN