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General NPI Number Information
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NPI Number | 1194734467
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Entity Type | Individual
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Provider Name | MARY CANDACE WHITEHURST MD
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Gender | Female
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 930 W 21ST ST SUITE 100
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City | NORFOLK
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State | VA
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Zip | 23517-1516
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Country | US
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Telephone | 757-622-8358
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Fax | 757-622-7171
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Provider Business Mailing Address
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Address Line | 7007 HARBOUR VIEW BLVD SUITE 108
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City | SUFFOLK
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State | VA
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Zip | 23435-3657
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Country | US
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Telephone | 757-215-2784
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Fax | 757-215-2728
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101041536
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License Number State | VA
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