Provider Demographics
NPI:1225039845
Name:WHITEHEAD, DAVID C JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:WHITEHEAD
Suffix:JR
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 1:1831 RESERVOIR ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8743
Mailing Address - Country:US
Mailing Address - Phone:540-433-9151
Mailing Address - Fax:540-433-0547
Practice Address - Street 1:1831 RESERVOIR ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8743
Practice Address - Country:US
Practice Address - Phone:540-433-9151
Practice Address - Fax:540-433-0547
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101023729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA011307OtherANTHEM ID
VA145610OtherSOUTHERN HEALTH ID
VAB08580Medicare UPIN