Provider Demographics
NPI:1447223433
Name:WHITE, REBECCA L (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 KINARD ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2909
Mailing Address - Country:US
Mailing Address - Phone:803-405-0220
Mailing Address - Fax:803-405-0222
Practice Address - Street 1:2525 KINARD ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2909
Practice Address - Country:US
Practice Address - Phone:803-405-0220
Practice Address - Fax:803-405-0222
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30575208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0444810Medicaid
IA37568OtherBC/BS PROVIDER NUMBER
IA0444810Medicaid
IAI17873Medicare UPIN