Provider Demographics
NPI:1023040003
Name:WHITE, REGINA (PA-C)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MSPAS
Mailing Address - Street 1:4 LIFE MARK DR
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1577
Mailing Address - Country:US
Mailing Address - Phone:215-453-4773
Mailing Address - Fax:215-453-4719
Practice Address - Street 1:4 LIFE MARK DR
Practice Address - Street 2:GRAND VIEW EMERGENCY MEDICINE ASSOCIATES
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1577
Practice Address - Country:US
Practice Address - Phone:215-453-4773
Practice Address - Fax:215-453-4719
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003448L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P27502Medicare UPIN
PA099562Medicare ID - Type Unspecified