Provider Demographics
NPI:1750330106
Name:WHITE ROSE FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:WHITE ROSE FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:717-741-9462
Mailing Address - Street 1:80 WYNTRE BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4535
Mailing Address - Country:US
Mailing Address - Phone:717-741-9462
Mailing Address - Fax:717-741-4399
Practice Address - Street 1:80 WYNTRE BROOKE DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4535
Practice Address - Country:US
Practice Address - Phone:717-741-9462
Practice Address - Fax:717-741-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS183OtherGEISINGER HEALTH PLAN
PA2601158OtherAETNA
PA02377500OtherCAPITAL BLUE CROSS
PA001873963Medicaid
PA371424OtherMAMSI
PA606644OtherHIGHMARK BLUE SHIELD
PA136324OtherHEALTH AMERICA
PA1520948OtherGATEWAY HEALTH PLAN
PA02377500OtherCAPITAL BLUE CROSS
PA001873963Medicaid