Provider Demographics
NPI:1487653325
Name:WHITE, ROBERT MARION (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARION
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 RIVERSIDE CIR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4961
Mailing Address - Country:US
Mailing Address - Phone:540-581-0150
Mailing Address - Fax:540-985-4537
Practice Address - Street 1:1 RIVERSIDE CIR
Practice Address - Street 2:SUITE 105
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4961
Practice Address - Country:US
Practice Address - Phone:540-581-0150
Practice Address - Fax:540-985-4537
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032012207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006606393Medicaid
WV0101558000Medicaid
220030574OtherRAILROAD MEDICARE
WV0101558000Medicaid
VA220000716Medicare PIN