MEDICARE: RONALD A WHITE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	MA048362	NJ

General Provider Information

NPI Number	:	1578759239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD A WHITE MD

Provider Business Mailing Address
First Line	:	216 ENGLE ST
Second Line	:
City	:	ENGLEWOOD
State	:	NJ
Zip	:	07631-2444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 UNION ST
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-4478
Country	:	US
Telephone Number	:	201-447-4466
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RONALD A WHITE
Credential	:	MD
Telephone Number	:	972-758-3595

Provider Enumeration Date	:	09/17/2007
Last Update Date	:	04/20/2008

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