Provider Demographics
NPI:1578675179
Name:WHITE, ANNE L (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:L
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1255 CREEKSHIRE WAY STE 290
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3061
Mailing Address - Country:US
Mailing Address - Phone:336-659-2663
Mailing Address - Fax:336-659-2665
Practice Address - Street 1:1255 CREEKSHIRE WAY STE 290
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3061
Practice Address - Country:US
Practice Address - Phone:336-659-2663
Practice Address - Fax:336-659-2665
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29552207N00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8927324Medicaid
2279954Medicare PIN
NCD26882Medicare UPIN