Provider Demographics
NPI:1457326688
Name:WHITE, KATHLEEN P (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3222
Mailing Address - Country:US
Mailing Address - Phone:203-288-9650
Mailing Address - Fax:203-288-9670
Practice Address - Street 1:2440 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3222
Practice Address - Country:US
Practice Address - Phone:203-288-9650
Practice Address - Fax:203-288-9670
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP2567544OtherOXFORD
CT2660903OtherAETNA
CT735531OtherCONNECTICARE
CT010035206CT01OtherANTHEM BC BS CT
CT0Q2022OtherHEALTH NET
CT2016866OtherUNITED HEALTHCARE
CT2335890002OtherCIGNA
CT735531OtherCONNECTICARE