MEDICARE: RANDAL WHITE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	27339	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184629297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDAL WHITE M.D.

Provider Business Mailing Address
First Line	:	628 E 12TH ST
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-3409
Country	:	US
Telephone Number	:	252-948-4990
Fax Number	:	252-948-4993

Provider Business Practice Location Address
First Line	:	628 E 12TH ST
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-3409
Country	:	US
Telephone Number	:	252-948-4990
Fax Number	:	252-948-4993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	01/12/2010

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Directions to “ RANDAL WHITE M.D.” Practice Location

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