MEDICARE: TERESA TRUONG WHITE PA

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	363A00000X	Physician Assistant	0010-12371	NC

General Provider Information

NPI Number	:	1801514161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA TRUONG WHITE PA

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 E W T HARRIS BLVD
Second Line	:	STE 5500A
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-3485
Country	:	US
Telephone Number	:	704-863-1520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	04/21/2026

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