Healthcare Provider Details

I. General information

NPI: 1346532421
Provider Name (Legal Business Name): ELIZABETH M. WHITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IVY DEVELOPMENTAL PEDIATRICS

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 REIVERS RUN
CHARLOTTESVILLE VA
22901-8829
US

IV. Provider business mailing address

2107 REIVERS RUN
CHARLOTTESVILLE VA
22901-8829
US

V. Phone/Fax

Practice location:
  • Phone: 843-364-6896
  • Fax: 866-360-2236
Mailing address:
  • Phone: 434-218-0640
  • Fax: 866-360-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101256422
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number0101256422
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: