Provider Demographics
NPI:1568466134
Name:WHITE, ROBERT SILLIMAN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SILLIMAN
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1028
Mailing Address - Country:US
Mailing Address - Phone:203-214-8768
Mailing Address - Fax:
Practice Address - Street 1:64 TRUMBULL ST 2
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-1028
Practice Address - Country:US
Practice Address - Phone:203-214-8768
Practice Address - Fax:203-752-9387
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0176612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001176619Medicaid
CT001176619Medicaid
CT260004147Medicare ID - Type Unspecified