Provider Demographics
NPI:1427686344
Name:WHITAKER, CONNOR (MD)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:
Last Name:WHITAKER
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 1:2101 W LEHIGH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-2664
Mailing Address - Country:US
Mailing Address - Phone:267-866-7211
Mailing Address - Fax:267-546-4064
Practice Address - Street 1:2101 W LEHIGH AVE STE A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-2664
Practice Address - Country:US
Practice Address - Phone:267-866-7211
Practice Address - Fax:267-546-4064
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD481657207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine