Provider Demographics
NPI:1518981257
Name:WHITE, DAMON J SR (PA-C)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:J
Last Name:WHITE
Suffix:SR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 HURFFVILLE CROSSKEYS RD
Mailing Address - Street 2:STE 1
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9369
Mailing Address - Country:US
Mailing Address - Phone:856-582-7979
Mailing Address - Fax:856-582-4259
Practice Address - Street 1:449 HURFFVILLE-CROSSKEYS ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9369
Practice Address - Country:US
Practice Address - Phone:856-582-7979
Practice Address - Fax:856-582-4259
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00096100363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP81134Medicare UPIN