Provider Demographics
NPI:1356367080
Name:WHITE, LENA KATHERINE (MD)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:KATHERINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11531 WINNERS CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-9076
Mailing Address - Country:US
Mailing Address - Phone:704-222-4631
Mailing Address - Fax:704-432-1126
Practice Address - Street 1:249 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1003
Practice Address - Country:US
Practice Address - Phone:704-222-4631
Practice Address - Fax:704-432-1126
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891060UMedicaid
NC891060UMedicaid
NCC81745Medicare UPIN