Provider Demographics
NPI:1619970548
Name:WHITE, PATRICK W (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:W
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 1:1 SEAGATE # 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:675-851-9645
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:5700 MONROE ST UNIT 101
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2779
Practice Address - Country:US
Practice Address - Phone:419-291-6777
Practice Address - Fax:419-480-6607
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045329W208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4037452OtherAETNA
000000223921OtherANTHEM
00213OtherPARAMOUNT
OH0437398Medicaid
OH$$$$$$$$$00OtherOHIO WORKERS COMPENSATION
00213OtherPARAMOUNT
4037452OtherAETNA
OH0437398Medicaid
OH$$$$$$$$$00OtherOHIO WORKERS COMPENSATION