Provider Demographics
NPI:1578005286
Name:WHITE, WESTLEY A (PA)
Entity Type:Individual
Prefix:
First Name:WESTLEY
Middle Name:A
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GUEST ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2040
Mailing Address - Country:US
Mailing Address - Phone:617-738-8642
Mailing Address - Fax:
Practice Address - Street 1:20 GUEST ST
Practice Address - Street 2:SUITE 225
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2040
Practice Address - Country:US
Practice Address - Phone:617-738-8642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5974363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical