Provider Demographics
NPI:1093814915
Name:WHITTEN, C. LARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:C. LARRY
Middle Name:
Last Name:WHITTEN
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 1:560 S MASON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3243
Mailing Address - Country:US
Mailing Address - Phone:540-434-3831
Mailing Address - Fax:540-432-0518
Practice Address - Street 1:2291 EVELYN BYRD AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5424
Practice Address - Country:US
Practice Address - Phone:540-434-3831
Practice Address - Fax:540-432-0518
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041222207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B08933Medicare UPIN