Provider Demographics
NPI:1629096573
Name:WHITE, SARA LORRAINE (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LORRAINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:WHITE
Other - Last Name:GAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5801 BREMO RD
Mailing Address - Street 2:ST MARY'S HOSPITAL PICU
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1907
Mailing Address - Country:US
Mailing Address - Phone:804-281-8222
Mailing Address - Fax:804-281-8007
Practice Address - Street 1:5801 BREMO RD
Practice Address - Street 2:ST MARY'S HOSPITAL PICU
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-281-8222
Practice Address - Fax:804-281-8007
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
VA01010498342080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09463OtherGROUP PTAN
VAC09463OtherGROUP PTAN