1427018829 NPI number — DR. JAMES F WITKO MD, FCCP

Table of content: DR. JAMES F WITKO MD, FCCP (NPI 1427018829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427018829 NPI number — DR. JAMES F WITKO MD, FCCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WITKO
Provider First Name:
JAMES
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, FCCP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427018829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2210 WILBORN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BOSTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24592-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-575-5864
Provider Business Mailing Address Fax Number:
434-575-8929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2210 WILBORN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BOSTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24592-1630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-575-5864
Provider Business Practice Location Address Fax Number:
434-575-8929
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  0101042054 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 88661 . This is a "BC/BS OF NC PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 006013899 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 032654 . This is a "ANTHEM BC PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2317122 . This is a "MEDICARE GROUP #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890556G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com