Healthcare Provider Details

I. General information

NPI: 1265690804
Provider Name (Legal Business Name): DR. MICHAEL ALEXANDER WHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD SUITE 506
RICHMOND VA
23226-1930
US

IV. Provider business mailing address

5855 BREMO RD SUITE 506
RICHMOND VA
23226-1930
US

V. Phone/Fax

Practice location:
  • Phone: 804-893-8676
  • Fax: 804-285-0360
Mailing address:
  • Phone: 804-893-8676
  • Fax: 804-285-0360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101259981
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: