Provider Demographics
NPI:1073591657
Name:WITKOFF, MAURY (DO)
Entity Type:Individual
Prefix:
First Name:MAURY
Middle Name:
Last Name:WITKOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 VILLAGE AT BEXLEY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2896
Mailing Address - Country:US
Mailing Address - Phone:614-402-3668
Mailing Address - Fax:
Practice Address - Street 1:6001 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-224-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-005979207P00000X
WV3069207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155924Medicaid
OH0155924Medicaid
OHWI4216732Medicare PIN
OHMA4114883Medicare PIN
OHP00619431Medicare PIN
OHWI4216731Medicare PIN