Provider Demographics
NPI:1023053485
Name:MCWHITE, KERTRISA R (MD)
Entity type:Individual
Prefix:DR
First Name:KERTRISA
Middle Name:R
Last Name:MCWHITE
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 1:28 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3654
Mailing Address - Country:US
Mailing Address - Phone:860-358-2850
Mailing Address - Fax:
Practice Address - Street 1:540 SAYBROOK RD STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4760
Practice Address - Country:US
Practice Address - Phone:860-358-2850
Practice Address - Fax:860-358-8661
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT675472086X0206X
OK281822086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008101457Medicaid
ALZ51050OtherVIVA HEALTH
AL8708239OtherCIGNA
AL204295Medicaid
AL8708239OtherCIGNA