Provider Demographics
NPI:1194931972
Name:WHITE, DONNA M (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-3313
Mailing Address - Country:US
Mailing Address - Phone:518-475-1297
Mailing Address - Fax:
Practice Address - Street 1:60 HANCOCK DR
Practice Address - Street 2:
Practice Address - City:GLENMONT
Practice Address - State:NY
Practice Address - Zip Code:12077-3313
Practice Address - Country:US
Practice Address - Phone:518-475-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1804612081H0002X
OH35-0518072081H0002X
KY197902081H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081H0002XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationHospice and Palliative Medicine