Individual
DR. MARK DOUGLAS WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
650 PETER JEFFERSON PKWY STE 290, CHARLOTTESVILLE, VA 22911-8848
(434) 297-7140
(434) 297-7235
Mailing address
5495 MAPLE LANE, FAYETTEVILLE, WV 25840-9589
(304) 574-1888
(304) 574-1891
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101264388
VA
207Q00000X
Family Medicine Physician
14161
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0057307000
—
WV
Enumeration date
06/14/2006
Last updated
01/18/2022
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