Provider Demographics
NPI:1568485365
Name:WHITE, THOMAS R (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
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 1:301 E. MAIN STREET PO BOX 1088
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHERRYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28021
Mailing Address - Country:US
Mailing Address - Phone:704-678-3221
Mailing Address - Fax:704-802-4551
Practice Address - Street 1:301 E. MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:CHERRYVILLE
Practice Address - State:NC
Practice Address - Zip Code:28021
Practice Address - Country:US
Practice Address - Phone:704-678-3221
Practice Address - Fax:704-802-4551
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8987114Medicaid
NC8987114Medicaid
NCNCE227AMedicare PIN
NC203169JMedicare PIN