Provider Demographics
NPI:1417414541
Name:THOMPSON-WHITE, DOROTHEA J
Entity Type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:J
Last Name:THOMPSON-WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CARMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6805
Mailing Address - Country:US
Mailing Address - Phone:516-729-3669
Mailing Address - Fax:
Practice Address - Street 1:16 CARMAN BLVD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6805
Practice Address - Country:US
Practice Address - Phone:516-729-3669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty