Provider Demographics
NPI:1952622243
Name:WHITE, PETER HOLLAND (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:HOLLAND
Last Name:WHITE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:1400 JOHNSTON WILLIS DR
Practice Address - Street 2:STE A
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4765
Practice Address - Country:US
Practice Address - Phone:804-379-8088
Practice Address - Fax:804-560-9029
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL32819207X00000X
VA0101260425207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery