Provider Demographics
NPI:1801208939
Name:WHITE, MITCHELL AARON (PA-C)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:AARON
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5058 CITY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1441
Mailing Address - Country:US
Mailing Address - Phone:215-921-6369
Mailing Address - Fax:215-921-6987
Practice Address - Street 1:5058 CITY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1441
Practice Address - Country:US
Practice Address - Phone:215-921-6369
Practice Address - Fax:215-921-6987
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056847363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical