Provider Demographics
NPI:1235121104
Name:WHITE, THOMAS ERIC (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ERIC
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:T.
Other - Middle Name:ERIC
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11108 PARKVIEW CIRCLE DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1730
Practice Address - Country:US
Practice Address - Phone:260-266-5700
Practice Address - Fax:260-266-5920
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039744A207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH06552OtherMEDICAID OH PARAMOUNT
OH060071113OtherRR MEDICARE
IN000000641099OtherANTHEM
INP00825392OtherR.R. MEDICARE
IN200074390Medicaid
OHP00846099OtherMEDICARE RAILROAD
IN060070589OtherRR MEDICARE
OH060071113OtherRR MEDICARE
OHP00846099OtherMEDICARE RAILROAD
IN193590QMedicare PIN
OH06552OtherMEDICAID OH PARAMOUNT
OHWH0813648Medicare PIN
IN200074390Medicaid
IN264380NMedicare PIN
IN193580RMedicare PIN