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General NPI Number Information
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NPI Number | 1326495185
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Entity Type | Individual
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Provider Name | MARY WHITE PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/20/2016
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Last Update Date | 08/23/2024
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Provider Practice Location Address
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Address Line | 114 WOODLAND ST DEPARTMENT OF SURGERY
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City | HARTFORD
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State | CT
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Zip | 06105-1208
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Country | US
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Telephone | 860-714-5237
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Fax |
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Provider Business Mailing Address
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Address Line | 71 MEADOWCREST LN
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City | WATERTOWN
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State | CT
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Zip | 06795-2406
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Country | US
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Telephone | 860-417-8239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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