Healthcare Provider Details

I. General information

NPI: 1265699078
Provider Name (Legal Business Name): MOLLY J. WHITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 ASHTON AVE SUITE 101
MANASSAS VA
20109-1710
US

IV. Provider business mailing address

P.O. BOX 37189
BALTIMORE MD
21297-3189
US

V. Phone/Fax

Practice location:
  • Phone: 703-257-8090
  • Fax: 703-257-7822
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101243967
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: