Provider Demographics
NPI:1952356263
Name:BUSBY-WHITEHEAD, MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:BUSBY-WHITEHEAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:BUSBY-WHITEHEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5003 OLD CLINIC
Mailing Address - Street 2:CB # 7550
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7550
Mailing Address - Country:US
Mailing Address - Phone:919-966-5945
Mailing Address - Fax:919-962-9795
Practice Address - Street 1:6011 FARRINGTON RD.
Practice Address - Street 2:BLDG. 100
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517
Practice Address - Country:US
Practice Address - Phone:919-957-6599
Practice Address - Fax:919-843-7231
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400213207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8986953Medicaid
NC8986953Medicaid
NCD65725Medicare UPIN