Provider Demographics
NPI:1578524500
Name:WHITE, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
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 1:130 HUNTER STATION WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-8930
Mailing Address - Country:US
Mailing Address - Phone:812-248-0800
Mailing Address - Fax:812-248-0805
Practice Address - Street 1:130 HUNTER STATION WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-8930
Practice Address - Country:US
Practice Address - Phone:812-248-0800
Practice Address - Fax:812-248-0805
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34240207R00000X, 208000000X
IN01050472207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200341770AMedicaid
G91151Medicare UPIN
IN133610BMedicare PIN
IN182650Medicare ID - Type Unspecified