Provider Demographics
NPI:1629013123
Name:WHYTE, ANDREW S (DO)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:S
Last Name:WHYTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06039
Mailing Address - Country:US
Mailing Address - Phone:800-795-5820
Mailing Address - Fax:
Practice Address - Street 1:50 HOSPITAL HILL DR
Practice Address - Street 2:ER DEPARTMENT
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069
Practice Address - Country:US
Practice Address - Phone:800-795-5820
Practice Address - Fax:616-975-9728
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000542207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP00198288Medicare PIN
H19966Medicare UPIN