Provider Demographics
NPI:1740230564
Name:WHITE, THOMAS G (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8235
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:
Practice Address - Street 1:85 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1149
Practice Address - Country:US
Practice Address - Phone:716-857-8623
Practice Address - Fax:716-250-5907
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163328-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110019235OtherRR MEDICARE
NY0403942OtherIHA
NY161000580OtherNORTH AMERICAN PREFERRED
NY161000580OtherNOVA
NY161000580OtherEMPIRE
NY163328-8WOtherWORKERS COMPENSATION
NY000506123001OtherHEALTH NOW
NY01027063Medicaid
NY00010188501OtherUNIVERA