Basic Information
| Provider Information | |||||||||
| NPI: | 1205877578 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5520 CHEVIOT ROAD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452477069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134514033 | ||||||||
| FaxNumber: | 5134514118 | ||||||||
| Practice Location | |||||||||
| Address1: | 2452 KIPLING AVENUE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452396650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136817800 | ||||||||
| FaxNumber: | 5138533045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 05/12/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 35058268 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 35-058268 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0741282 | 05 | OH | MEDICAID |