Provider Demographics
NPI:1003290313
Name:WHITE, MARY (PA)
Entity Type:Individual
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First Name:MARY
Middle Name:
Last Name:WHITE
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Gender:F
Credentials:PA
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Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:603-319-8308
Practice Address - Street 1:543 BROADWAY
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3337
Practice Address - Country:US
Practice Address - Phone:207-922-1300
Practice Address - Fax:207-217-6742
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2024-04-08
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Provider Licenses
StateLicense IDTaxonomies
MEPA1553363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant