Provider Demographics
NPI:1902933740
Name:WHITE, PATRICIA S (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:S
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:PO BOX 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-304-7000
Mailing Address - Fax:704-304-7008
Practice Address - Street 1:2001 VAIL AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1248
Practice Address - Country:US
Practice Address - Phone:704-304-7000
Practice Address - Fax:704-304-7008
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1056UOtherBCBS NC
NC1902933740Medicaid
SCN34769Medicaid
NC8986997Medicaid
NC8986997Medicaid
NC2167459EMedicare PIN
SCN34769Medicaid
NC080169635Medicare PIN
NC2167459FMedicare PIN