Provider Demographics
NPI:1104961424
Name:WHITTIER, RONALD HAROLD
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:HAROLD
Last Name:WHITTIER
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:PO BOX 211
Mailing Address - Street 2:184 RICKER RD
Mailing Address - City:NRE GLOUCESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04260
Mailing Address - Country:US
Mailing Address - Phone:207-926-8853
Mailing Address - Fax:207-926-3241
Practice Address - Street 1:184 RICKER RD
Practice Address - Street 2:
Practice Address - City:NEW GLOUCESTER
Practice Address - State:ME
Practice Address - Zip Code:04260-3250
Practice Address - Country:US
Practice Address - Phone:207-926-8853
Practice Address - Fax:207-926-3241
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3002103385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care