Active NPI
Charles W Whittenberg, MD
- Pediatrics Physician
- Simpsonville, SC
National Provider Identifier
1760495188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 8964
- Practice address
- 408 SE Main St
Simpsonville, SC 29681 - Phone
- (864) 228-8010
- NPI assigned
- Aug 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 8964 | SC | Primary |
Addresses
Primary practice location
408 SE Main St
Simpsonville, SC 29681
Mailing address
408 SE Main St
Simpsonville, SC 29681
Phone (864) 228-8010
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP2981 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8964 | SC | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760495188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "408 SE MAIN ST",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "29681",
"telephone_number": "864-228-8010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 SE MAIN ST",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "29681",
"telephone_number": "864-228-8010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITTENBERG",
"first_name": "CHARLES",
"middle_name": "W",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "SC",
"license": "8964",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP2981",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Simpsonville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.