Provider Demographics
NPI:1194734467
Name:WHITEHURST, MARY CANDACE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CANDACE
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7007 HARBOUR VIEW BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3657
Mailing Address - Country:US
Mailing Address - Phone:757-215-2784
Mailing Address - Fax:757-215-2728
Practice Address - Street 1:930 W 21ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1516
Practice Address - Country:US
Practice Address - Phone:757-622-8358
Practice Address - Fax:757-622-7171
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-05-25
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Provider Licenses
StateLicense IDTaxonomies
VA0101041536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5824826Medicaid
VA13900OtherOPTIMA HEALTH PLAN
VA325493OtherANTHEM BLUE CROSS BLUE SH
VA011268OtherCIGNA HEALTH PLAN
VA1100181707OtherRAILROAD MEDICARE
VA011268OtherCIGNA HEALTH PLAN
VAVV1813AMedicare PIN
VA1100181707OtherRAILROAD MEDICARE