Healthcare Provider Details

I. General information

NPI: 1831570738
Provider Name (Legal Business Name): MICHAEL PAUL WHITE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

267 GRANT ST
BRIDGEPORT CT
06610-2805
US

V. Phone/Fax

Practice location:
  • Phone: 781-267-5951
  • Fax:
Mailing address:
  • Phone: 203-384-4048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number69437
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number299159
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: