Provider Demographics
NPI:1811958648
Name:WHITEHEAD, RICHARD E (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:199 REEDSDALE ROAD
Mailing Address - Street 2:DEPT OF DIAGNOSTIC IMAGING, MILTON HOSPITAL
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186
Mailing Address - Country:US
Mailing Address - Phone:617-696-4600
Mailing Address - Fax:617-313-1526
Practice Address - Street 1:199 REEDSDALE ROAD
Practice Address - Street 2:DEPT OF DIAGNOSTIC IMAGING, MILTON HOSPITAL
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:617-696-4600
Practice Address - Fax:617-313-1526
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1517172085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3164764Medicaid
MA3164764Medicaid
MAG43669Medicare UPIN