Provider Demographics
NPI:1851498588
Name:WHITE, MELVIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:C
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CHRIS GAUPP DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4440
Mailing Address - Country:US
Mailing Address - Phone:609-748-7580
Mailing Address - Fax:
Practice Address - Street 1:415 CHRIS GAUPP DR
Practice Address - Street 2:SUITE C
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4440
Practice Address - Country:US
Practice Address - Phone:609-748-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39182207RC0000X
PAMD020090E207RC0000X
NJ25MA03918200207RC0001X
FLME 75675207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
105358OtherAMERIHEALTH PPO
2143144OtherAETNA
NJ2299101Medicaid
CA0000366 00OtherAMERICHOICE
1099284OtherHORIZON NJ HEALTH
3K6135OtherHEALTHNET
6767066OtherCIGNA
P857757OtherOXFORD HEALTH PLAN
24278OtherUNIVERSITY HEALTH PLAN
110184414OtherRAIL ROAD MEDICARE
0079769000OtherAMERIHEALTH, HMO, KEYSTONE, IBC
1830734OtherUNITED HEALTH CARE
105358OtherAMERIHEALTH PPO
3K6135OtherHEALTHNET