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General NPI Number Information
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NPI Number | 1518981257
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Entity Type | Individual
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Provider Name | DAMON J WHITE SR. P.A.-C.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 449 HURFFVILLE-CROSSKEYS ROAD SUITE 1
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City | SEWELL
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State | NJ
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Zip | 08080-9369
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Country | US
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Telephone | 856-582-7979
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Fax | 856-582-4259
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Provider Business Mailing Address
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Address Line | 449 HURFFVILLE CROSSKEYS RD STE 1
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City | SEWELL
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State | NJ
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Zip | 08080-9369
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Country | US
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Telephone | 856-582-7979
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Fax | 856-582-4259
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00096100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00096100
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License Number State | NJ
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