Provider Demographics
NPI:1841440286
Name:WHITE, ROBERT WILLIAM (CO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:WHITE
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 TURNPIKE DR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1830
Mailing Address - Country:US
Mailing Address - Phone:203-758-8307
Mailing Address - Fax:
Practice Address - Street 1:80 TURNPIKE DR
Practice Address - Street 2:UNIT 1
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1830
Practice Address - Country:US
Practice Address - Phone:203-758-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier