Provider Demographics
NPI:1447581178
Name:WHITE, VERA-ELLEN FRANCES (MD)
Entity Type:Individual
Prefix:DR
First Name:VERA-ELLEN
Middle Name:FRANCES
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VERONICA-ELLEN
Other - Middle Name:F
Other - Last Name:WHITE-RUDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:82 INLETVIEW PATH
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940
Mailing Address - Country:US
Mailing Address - Phone:631-878-4860
Mailing Address - Fax:631-878-4860
Practice Address - Street 1:82 INLETVIEW PATH
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940
Practice Address - Country:US
Practice Address - Phone:631-878-4860
Practice Address - Fax:631-878-4860
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186068-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01350210Medicaid
95F041Medicare PIN
NY01350210Medicaid