Provider Demographics
NPI:1710961438
Name:WHITT, DAVID EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:WHITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7694 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8827
Mailing Address - Country:US
Mailing Address - Phone:614-920-9815
Mailing Address - Fax:
Practice Address - Street 1:7901 DILEY RD
Practice Address - Street 2:SUITE 260
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9612
Practice Address - Country:US
Practice Address - Phone:614-920-1000
Practice Address - Fax:614-920-1007
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2124329Medicaid
JA9184581Medicare ID - Type Unspecified
OH2124329Medicaid