Provider Demographics
NPI:1720424450
Name:WHITE PLAINS PRIMARY CARE
Entity Type:Organization
Organization Name:WHITE PLAINS PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-417-6424
Mailing Address - Street 1:4550 CRAIN HWY
Mailing Address - Street 2:STE 102
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3015
Mailing Address - Country:US
Mailing Address - Phone:240-349-2448
Mailing Address - Fax:240-349-2243
Practice Address - Street 1:4550 CRAIN HWY
Practice Address - Street 2:STE 102
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3015
Practice Address - Country:US
Practice Address - Phone:240-349-2448
Practice Address - Fax:240-349-2243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR120765363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty