Provider Demographics
NPI:1740255975
Name:WHITE, PHILLIP ALLEN (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ALLEN
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 1:3200 BURNET AVE
Mailing Address - Street 2:3 SOUTH
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3019
Mailing Address - Country:US
Mailing Address - Phone:513-585-5503
Mailing Address - Fax:513-475-8033
Practice Address - Street 1:7700 UNIVERSITY CT
Practice Address - Street 2:SUITE 3500
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6542
Practice Address - Country:US
Practice Address - Phone:513-475-8730
Practice Address - Fax:513-475-8273
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-6474-W2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2137833Medicaid
OHP00031539OtherMEDICARE RR
OHP00031539OtherMEDICARE RR
OH4099281Medicare PIN
OHWH0883478Medicare PIN