Provider Demographics
NPI:1982105748
Name:WHIPPLE, MATTHEW RICHARDSON (RDN, LDN)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:RICHARDSON
Last Name:WHIPPLE
Suffix:
Gender:M
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 GERRITT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-4107
Mailing Address - Country:US
Mailing Address - Phone:985-232-3435
Mailing Address - Fax:
Practice Address - Street 1:2346 GERRITT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-4107
Practice Address - Country:US
Practice Address - Phone:985-232-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006189133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered