Provider Demographics
NPI:1508929571
Name:WHITE, PATRICK WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WILLIAM
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 1:2850 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7604
Mailing Address - Country:US
Mailing Address - Phone:410-746-9509
Mailing Address - Fax:410-465-2920
Practice Address - Street 1:19301 WATKINS MILL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-6914
Practice Address - Country:US
Practice Address - Phone:410-745-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23365173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD336611101Medicaid
MD9071Medicare ID - Type Unspecified
MDD73903Medicare UPIN