Provider Demographics
NPI:1487185187
Name:WHITESIDE, AILA CO (MD)
Entity Type:Individual
Prefix:
First Name:AILA
Middle Name:CO
Last Name:WHITESIDE
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 1:7750 DILEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7758
Mailing Address - Country:US
Mailing Address - Phone:614-837-7337
Mailing Address - Fax:614-837-7335
Practice Address - Street 1:2088 PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-4014
Practice Address - Country:US
Practice Address - Phone:757-668-6700
Practice Address - Fax:757-668-6680
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.030225208000000X
VA0101279051208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0409330Medicaid