Provider Demographics
NPI:1760772818
Name:WHITEWAY, ROGER NEWELL (CS)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:NEWELL
Last Name:WHITEWAY
Suffix:
Gender:M
Credentials:CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 CRYSTAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3850
Mailing Address - Country:US
Mailing Address - Phone:757-635-5724
Mailing Address - Fax:
Practice Address - Street 1:1152 CRYSTAL LAKE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-3850
Practice Address - Country:US
Practice Address - Phone:757-635-5724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner