Healthcare Provider Details

I. General information

NPI: 1063947133
Provider Name (Legal Business Name): ROBERT M. WHITE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12054 EAGLEWOOD CT
SILVER SPRING MD
20902-1876
US

IV. Provider business mailing address

12054 EAGLEWOOD CT
SILVER SPRING MD
20902-1876
US

V. Phone/Fax

Practice location:
  • Phone: 301-949-3510
  • Fax:
Mailing address:
  • Phone: 301-949-3510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD12883
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: