Provider Demographics
NPI:1851098305
Name:WHITE, CARL JR
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:WHITE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 DUBOIS PL SE APT 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-2452
Mailing Address - Country:US
Mailing Address - Phone:202-270-0368
Mailing Address - Fax:
Practice Address - Street 1:461 H ST NW APT 1015
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4715
Practice Address - Country:US
Practice Address - Phone:202-445-9408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant