Basic Information
| Provider Information | |||||||||
| NPI: | 1700977584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | INEZ | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 BOOTH ST | ||||||||
| Address2: | APT 103B | ||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208785463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019474705 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1241 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404341941 | ||||||||
| FaxNumber: | 5404338277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 11/16/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 010102029 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | MD12328 | MD | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 2004007322 | MO | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 004945166 | 05 | VA | MEDICAID | 198181 | 01 | VA | ANTHEM | OTHER | 089561M | 01 | VA | SENTARA OPTIMA | OTHER |