Provider Demographics
NPI:1063906477
Name:WHITING, DERRICK (DO)
Entity type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:
Last Name:WHITING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11761 ROCK LANDING DR STE 8
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4235
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:2205 EXECUTIVE DR STE C
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2948
Practice Address - Country:US
Practice Address - Phone:757-826-3460
Practice Address - Fax:757-826-5123
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11020144A207Q00000X
VA0102207020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine