Active NPI
Matthew T Whitehead, MD
- Neuroradiology Physician
- Philadelphia, PA
National Provider Identifier
1821203571
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neuroradiology Physician
- License
- MD476887
- Practice address
- 3401 Civic Center Blvd
Philadelphia, PA 19104-4319 - Phone
- (215) 590-1000
- NPI assigned
- May 14, 2007
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Neuroimaging (Radiology) Physician | 2085D0003X | MD041397 | DC | |
| Diagnostic Neuroimaging (Radiology) Physician | 2085D0003X | 0101254378 | MD | |
| Neuroradiology Physician | 2085N0700X | 47352 | TN | |
| Neuroradiology Physician | 2085N0700X | A108302 | CA | |
| Neuroradiology Physician | 2085N0700X | MD476887 | PA | Primary |
Addresses
Primary practice location
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Mailing address
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Other practice location 1
111 Michigan Ave NW
Washington, DC 20010-2916
Phone (202) 476-2497
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC, PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD041397 | DC | MD | Diagnostic Neuroimaging (Radiology) Physician |
| 0101254378 | MD | MD | Diagnostic Neuroimaging (Radiology) Physician |
| A108302 | CA | MD | Neuroradiology Physician |
| MD476887 | PA | MD | Neuroradiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Hospital | Current | Accepting new patients | |
| University of Penn-Medical Group | Current | Accepting new patients | |
| Children'S Hospital | Current | Accepting new patients | |
| University of Penn-Medical Group | Current | Accepting new patients | |
| University of Penn-Medical Group | Current | Accepting new patients | |
| Children'S Hospital | Current | Accepting new patients |
Locations
111 Michigan Ave NW
Washington, DC 20010
Phone (202) 476-3670
Organizations & group practices 6
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682553600000",
"number": "1821203571",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191044319",
"telephone_number": "215-590-1000"
}
],
"practiceLocations": [
{
"address_1": "111 Michigan Ave NW",
"address_purpose": "LOCATION",
"city": "Washington",
"state": "DC",
"postal_code": "200102916",
"country_code": "US",
"telephone_number": "202-476-2497",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WHITEHEAD",
"first_name": "MATTHEW",
"middle_name": "T",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-14",
"last_updated": "2023-04-27",
"certification_date": "2023-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "2085D0003X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Neuroimaging",
"state": "DC",
"license": "MD041397",
"primary": false
},
{
"code": "2085D0003X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Neuroimaging",
"state": "MD",
"license": "0101254378",
"primary": false
},
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "TN",
"license": "47352",
"primary": false
},
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "CA",
"license": "A108302",
"primary": false
},
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "PA",
"license": "MD476887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.