Provider Demographics
NPI:1306817689
Name:WHITE, CHRISTOPHER L (DO)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:L
Last Name:WHITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 DAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9302
Mailing Address - Country:US
Mailing Address - Phone:304-647-4411
Mailing Address - Fax:304-645-0970
Practice Address - Street 1:231 DAWKINS DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9674
Practice Address - Country:US
Practice Address - Phone:304-645-0870
Practice Address - Fax:304-645-0970
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200300207YS0123X
WV22204207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901335Medicaid
WV129458OtherMEDICAID UNICARE
NC2344771OtherGROUP MEDICARE
WV3810007432Medicaid
WV4198581Medicare UPIN
NC2402583Medicare ID - Type Unspecified
WV129458OtherMEDICAID UNICARE
I38033Medicare PIN