Provider Demographics
NPI:1720041361
Name:WHITE, KELLEY E (MD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:E
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 FOREST AVE
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1726
Mailing Address - Country:US
Mailing Address - Phone:804-282-7857
Mailing Address - Fax:804-282-7899
Practice Address - Street 1:7001 FOREST AVE
Practice Address - Street 2:SUITE 2500
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1726
Practice Address - Country:US
Practice Address - Phone:804-282-7857
Practice Address - Fax:804-282-7899
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010016975Medicaid
VA4339850OtherAETNA HMO
VA011174OtherCIGNA
VA110217730OtherRAILROAD MEDICARE
VA122915OtherSOUTHERN HEALTH SERVICES
VA4339850OtherAETNA LIFE
VA228213OtherANTHEM BCBS OF VA
VA291886OtherMAMSI
VA43934OtherSENTARA
VA010016975Medicaid
F58314Medicare UPIN