Provider Demographics
NPI:1346532421
Name:WHITE, ELIZABETH M (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IVY
Other - Middle Name:DEVELOPMENTAL
Other - Last Name:PEDIATRICS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2107 REIVERS RUN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8829
Mailing Address - Country:US
Mailing Address - Phone:434-218-0640
Mailing Address - Fax:866-360-2236
Practice Address - Street 1:2107 REIVERS RUN
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8829
Practice Address - Country:US
Practice Address - Phone:843-364-6896
Practice Address - Fax:866-360-2236
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012564222080P0006X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics