Provider Demographics
NPI:1003907080
Name:WHITE, KATHLEEN EVA (DO)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:EVA
Last Name:WHITE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:340 MAPLE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3200
Mailing Address - Country:US
Mailing Address - Phone:508-485-7779
Mailing Address - Fax:508-485-7769
Practice Address - Street 1:340 MAPLE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3200
Practice Address - Country:US
Practice Address - Phone:508-485-7779
Practice Address - Fax:508-485-7769
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA209026207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0148415Medicaid
MAA3353601Medicare PIN
MAH54773Medicare UPIN
MAM21354Medicare PIN