Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1507 | NC |
Y | 103T00000X | Psychologist | 1507 | NC |
N | 103G00000X | Clinical Psychologist | 1507 | NC |
N | 103TC0700X | Clinical Psychologist | 1507 | NC |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 1507 | NC |
N | 103TF0000X | Family Psychologist | 1507 | NC |
NPI | 1093859480 |
---|---|
Provider Name | Dr. Robert Reid Whiteside |
First Address | Cary, NC 27513-9653 |
Second Address | Cary, NC 27518-9133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2007 |
Last Update Date | 07/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0489C | NC BCBS PROVIDER NUMBER (01) | NC |