Healthcare Provider Details

I. General information

NPI: 1417028887
Provider Name (Legal Business Name): CAROL ANN WHITE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 PINEVIEW DR
MORGANTOWN WV
26505-0485
US

IV. Provider business mailing address

234 CARMICHAELS RD
CARMICHAELS PA
15320-2548
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-7546
  • Fax:
Mailing address:
  • Phone: 724-809-1325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number20351
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20351
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number20351
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20351
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: