Provider Demographics
NPI:1255319349
Name:WHITE, MICHAEL CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CRAIG
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:PO BOX 72605
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-8017
Mailing Address - Country:US
Mailing Address - Phone:804-379-0116
Mailing Address - Fax:
Practice Address - Street 1:6372 MECHANICSVILLE TPKE STE 103
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4710
Practice Address - Country:US
Practice Address - Phone:804-379-0116
Practice Address - Fax:804-379-1088
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043787207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA070000121Medicare ID - Type Unspecified
VAD91469Medicare UPIN