Provider Demographics
NPI:1255310686
Name:WHITE, ANDREW A (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:A
Last Name:WHITE
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 1:104 SELMA DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3834
Mailing Address - Country:US
Mailing Address - Phone:540-678-2800
Mailing Address - Fax:
Practice Address - Street 1:104 SELMA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3834
Practice Address - Country:US
Practice Address - Phone:540-678-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA674266OtherNCPPO
VA153806OtherANTHEM BCBS
VA2124799OtherMAMSI
WV2007224000Medicaid
WV2007224000Medicaid
VAP00120413Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VAC00075Medicare PIN
VA2124799OtherMAMSI