MEDICARE: DR. MARY CHRISTINA WHYTE 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	2086S0120X	Pediatric Surgery Physician	223982	NY

General Provider Information

NPI Number	:	1801954169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY CHRISTINA WHYTE MD

Provider Business Mailing Address
First Line	:	19 HILLS RD
Second Line	:
City	:	LOUDONVILLE
State	:	NY
Zip	:	12211-1320
Country	:	US
Telephone Number	:	518-262-5831
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 NEW SCOTLAND AVE
Second Line	:	MAIL CODE 191
City	:	ALBANY
State	:	NY
Zip	:	12208-3403
Country	:	US
Telephone Number	:	518-262-5831
Fax Number	:

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	12/07/2011

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