Provider Demographics
NPI:1093847949
Name:WITTE, TODD N (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:N
Last Name:WITTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:2979 SQUALICUM PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1811
Mailing Address - Country:US
Mailing Address - Phone:360-734-1420
Mailing Address - Fax:360-756-6666
Practice Address - Street 1:2979 SQUALICUM PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1811
Practice Address - Country:US
Practice Address - Phone:360-734-1420
Practice Address - Fax:360-756-6666
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00047632207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8478554Medicaid
WA8864830Medicare PIN
WAI71955Medicare UPIN