Provider Demographics
NPI:1316022379
Name:WITWER, TIMOTHY SLAYTON (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SLAYTON
Last Name:WITWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 NORTH ROAD STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:252-335-4351
Mailing Address - Fax:252-335-7932
Practice Address - Street 1:1207 NORTH ROAD STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-335-4351
Practice Address - Fax:252-335-7932
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC88709OtherBLUE CROSS
NC8988709Medicaid
NC8988709Medicaid
NC202293Medicare ID - Type Unspecified