Basic Information
Provider Information | |||||||||
NPI: | 1841200268 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WHITE | ||||||||
FirstName: | MARTHA | ||||||||
MiddleName: | V | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 11002 VEIRS MILL RD | ||||||||
Address2: | 414 | ||||||||
City: | WHEATON | ||||||||
State: | MD | ||||||||
PostalCode: | 209022574 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3019625800 | ||||||||
FaxNumber: | 3019629585 | ||||||||
Practice Location | |||||||||
Address1: | 11002 VEIRS MILL RD | ||||||||
Address2: | 414 | ||||||||
City: | WHEATON | ||||||||
State: | MD | ||||||||
PostalCode: | 209022574 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3019625800 | ||||||||
FaxNumber: | 3019629585 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/08/2006 | ||||||||
LastUpdateDate: | 10/23/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | D0056193 | MD | Y |   | Allopathic & Osteopathic Physicians | Allergy & Immunology |   |
ID Information
ID | Type | State | Issuer | Description | 27702 | 01 | MD | KAISER | OTHER | 423100 | 01 | MD | MAMSI | OTHER | 02-000154 | 01 | MD | UNITED HEALTHCARE | OTHER | 4349214 | 01 | MD | AETNA | OTHER |