1437485182 NPI number — MR. CHRISTOPHER WILLIAM WHITE ACNP-BC

Table of content: MR. CHRISTOPHER WILLIAM WHITE ACNP-BC (NPI 1437485182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437485182 NPI number — MR. CHRISTOPHER WILLIAM WHITE ACNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
CHRISTOPHER
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ACNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DONALD
Provider Other First Name:
CHRISTOPHER
Provider Other Middle Name:
WILLIAM
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437485182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 ENTERPRISE DR STE 4A
Provider Second Line Business Mailing Address:
EVERCARE/OPTUM
Provider Business Mailing Address City Name:
ROCKY HILL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06067-3913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-887-5682
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06518-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-887-5682
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  004229 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 004229 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D400044363 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: D400063711 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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