Healthcare Provider Details

I. General information

NPI: 1104330810
Provider Name (Legal Business Name): DR. WHITE'S VEIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 11/17/2017
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 TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROL ANN WHITE
Title or Position: MD
Credential: MD
Phone: 724-809-1325