Healthcare Provider Details

I. General information

NPI: 1962497818
Provider Name (Legal Business Name): EDWARD R. WHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MILES CENTER WAY
DAMARISCOTTA ME
04543-4047
US

IV. Provider business mailing address

24 MILES CENTER WAY
DAMARISCOTTA ME
04543-4047
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-1040
  • Fax: 207-563-1039
Mailing address:
  • Phone: 207-563-1040
  • Fax: 207-563-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number011872
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD11872
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: