Basic Information
| Provider Information | |||||||||
| NPI: | 1437260957 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 KINGSLEY LN STE 305 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235054617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578895422 | ||||||||
| FaxNumber: | 7578895450 | ||||||||
| Practice Location | |||||||||
| Address1: | 9670 26TH BAY ST | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235181808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077121018 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 0101239881 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085B0100X | 0101239881 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0202X | 0101239881 | VA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.