Provider Demographics
NPI:1114973815
Name:WHITE, WILLIAM BRADLEY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM BRADLEY
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894
Mailing Address - Country:US
Mailing Address - Phone:603-515-2093
Mailing Address - Fax:
Practice Address - Street 1:240 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4411
Practice Address - Country:US
Practice Address - Phone:603-515-2093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53532207X00000X
NH10599207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH017608Y0NH02OtherANTHEM BCBS MCH
NH0107608Y0NH03OtherANTHEM BCBS MOA
NH30000253Medicaid
NH017608Y0NH02OtherANTHEM BCBS MCH