Provider Demographics
NPI:1598866402
Name:WHITE, JOHN DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DOUGLAS
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 1:8720 CRIDER BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4547
Mailing Address - Country:US
Mailing Address - Phone:202-906-0788
Mailing Address - Fax:301-469-7138
Practice Address - Street 1:8720 CRIDER BROOK WAY
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4547
Practice Address - Country:US
Practice Address - Phone:202-906-0788
Practice Address - Fax:301-469-7138
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0041123207R00000X
VA0101053484207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
004018G60Medicare ID - Type Unspecified
E61863Medicare UPIN