Provider Demographics
NPI:1124254834
Name:WHALEN, MARK D (LIC AC, MAOM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:WHALEN
Suffix:
Gender:M
Credentials:LIC AC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PONDMEADOW DR STE 107
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3222
Mailing Address - Country:US
Mailing Address - Phone:781-626-1078
Mailing Address - Fax:
Practice Address - Street 1:20 PONDMEADOW DR STE 107
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3222
Practice Address - Country:US
Practice Address - Phone:781-626-1078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226329171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist