Provider Demographics
NPI:1376616565
Name:WHITE, ROBERT I (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:I
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 1:100 WASON AVENUE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1119
Mailing Address - Country:US
Mailing Address - Phone:413-241-2100
Mailing Address - Fax:813-735-1986
Practice Address - Street 1:100 WASON AVENUE
Practice Address - Street 2:SUITE 120
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1119
Practice Address - Country:US
Practice Address - Phone:413-241-2100
Practice Address - Fax:813-735-1986
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA35343208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH21069Medicare ID - Type Unspecified
MAB97670Medicare UPIN