Provider Demographics
NPI:1033112297
Name:DEWITT, ASUNCION U (MD)
Entity Type:Individual
Prefix:
First Name:ASUNCION
Middle Name:U
Last Name:DEWITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9524
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47808-9524
Mailing Address - Country:US
Mailing Address - Phone:812-244-0100
Mailing Address - Fax:812-232-1517
Practice Address - Street 1:1606 N 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2706
Practice Address - Country:US
Practice Address - Phone:812-244-0100
Practice Address - Fax:812-232-1517
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027303174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100324860AMedicaid
IN858090FMedicare ID - Type Unspecified
IND93983Medicare UPIN