Provider Demographics
NPI:1477751899
Name:WHITE, AMMIE M (MD)
Entity Type:Individual
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First Name:AMMIE
Middle Name:M
Last Name:WHITE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:100 E PENN SQ FL 9
Mailing Address - Street 2:RACH
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3377
Mailing Address - Country:US
Mailing Address - Phone:267-425-9232
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:RACH
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-7000
Practice Address - Fax:215-590-9348
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2016-02-10
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Provider Licenses
StateLicense IDTaxonomies
PAMD4462822085R0202X
VA01012561572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology