Provider Demographics
NPI:1003040726
Name:WITANOWSKI, STEPHEN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOHN
Last Name:WITANOWSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2700 QUARRY LAKE DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3742
Mailing Address - Country:US
Mailing Address - Phone:410-469-5544
Mailing Address - Fax:410-585-2867
Practice Address - Street 1:2700 QUARRY LAKE DR
Practice Address - Street 2:SUITE 280
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3742
Practice Address - Country:US
Practice Address - Phone:410-469-5544
Practice Address - Fax:410-585-2867
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-09
Last Update Date:2016-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0080458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine