=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194931972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNA M WHITE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 HANCOCK DR
-----------------------------------------------------
City | GLENMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12077-3313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-475-1297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 HANCOCK DR
-----------------------------------------------------
City | GLENMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12077-3313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-475-1297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081H0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 180461
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2081H0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 35-051807
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2081H0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 19790
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------