Provider Demographics
NPI:1386812451
Name:WHITSETT, MARC WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:WILLIAM
Last Name:WHITSETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 STATE ROUTE 222
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-9778
Mailing Address - Country:US
Mailing Address - Phone:513-753-9964
Mailing Address - Fax:
Practice Address - Street 1:50 W TECHNE CENTER DR
Practice Address - Street 2:SUITE B-5
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-8403
Practice Address - Country:US
Practice Address - Phone:513-753-9964
Practice Address - Fax:513-753-9968
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH046345207R00000X
OH35046345-W207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0782158Medicaid
OH0782158Medicaid