Provider Demographics
NPI:1659439537
Name:JOSEPH D. WHITE EAR, NOSE, THROAT MEDICINE & SURGERY PC
Entity Type:Organization
Organization Name:JOSEPH D. WHITE EAR, NOSE, THROAT MEDICINE & SURGERY PC
Other - Org Name:NORTHEAST ENT & ALLERGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:603-742-6555
Mailing Address - Street 1:158 NH ROUTE 108
Mailing Address - Street 2:SUITE B
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820
Mailing Address - Country:US
Mailing Address - Phone:603-742-6555
Mailing Address - Fax:603-742-3256
Practice Address - Street 1:158 NH ROUTE 108
Practice Address - Street 2:SUITE B
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-742-6555
Practice Address - Fax:603-742-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7239174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHCH6520OtherRAILROAD MEDICARE GROUP #
NH101020600OtherNH DEPT. OF LABOR GROUP #
NH30009351Medicaid
NH693OtherHEALTHSOURCE GROUP NUMBER
NH=========OtherANTHEM GROUP NUMBER
NH30009351Medicaid
RE2983Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER