Healthcare Provider Details

I. General information

NPI: 1508929571
Provider Name (Legal Business Name): PATRICK WILLIAM WHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19301 WATKINS MILL RD
MONTGOMERY VILLAGE MD
20886-6914
US

IV. Provider business mailing address

2850 PEBBLE BEACH DR
ELLICOTT CITY MD
21042-7604
US

V. Phone/Fax

Practice location:
  • Phone: 410-745-9509
  • Fax:
Mailing address:
  • Phone: 410-746-9509
  • Fax: 410-465-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberD23365
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: