Healthcare Provider Details

I. General information

NPI: 1184629297
Provider Name (Legal Business Name): RANDAL WHITE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 E 12TH ST
WASHINGTON NC
27889-3409
US

IV. Provider business mailing address

628 E 12TH ST
WASHINGTON NC
27889-3409
US

V. Phone/Fax

Practice location:
  • Phone: 252-948-4990
  • Fax: 252-948-4993
Mailing address:
  • Phone: 252-948-4990
  • Fax: 252-948-4993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number27339
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: