Provider Demographics
NPI:1114998101
Name:WITTENBERG, GEORGE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:WITTENBERG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 5TH AVE STE 811
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3232
Mailing Address - Country:US
Mailing Address - Phone:412-648-4178
Mailing Address - Fax:412-383-7214
Practice Address - Street 1:UNIVERSITY DR
Practice Address - Street 2:BLDG. 1, 10 EAST, RM 133
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15240
Practice Address - Country:US
Practice Address - Phone:412-360-6185
Practice Address - Fax:412-360-6920
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055622208100000X
PAMD4634472084P0301X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G62218Medicare UPIN
NC2280602AMedicare ID - Type Unspecified