Provider Demographics
NPI:1205877578
Name:WHITE, DANIEL R (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
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 1:5520 CHEVIOT ROAD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7069
Mailing Address - Country:US
Mailing Address - Phone:513-451-4033
Mailing Address - Fax:513-451-4118
Practice Address - Street 1:2452 KIPLING AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-6650
Practice Address - Country:US
Practice Address - Phone:513-681-7800
Practice Address - Fax:513-853-3045
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350582682085R0001X
OH35-0582682085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0741282Medicaid
E98527Medicare UPIN
OHE98527Medicare UPIN
OH0741282Medicaid
OHWH0647826Medicare ID - Type UnspecifiedMIDDLETOWN MCARE
OH0647827Medicare PIN