Provider Demographics
NPI:1427219674
Name:WITT, STEPHANIE J (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:WITT
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Gender:F
Credentials:DO
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Mailing Address - Street 1:2321 WARDS RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2101
Mailing Address - Country:US
Mailing Address - Phone:434-582-2273
Mailing Address - Fax:434-582-1363
Practice Address - Street 1:2321 WARDS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2101
Practice Address - Country:US
Practice Address - Phone:434-582-2273
Practice Address - Fax:434-582-1363
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2015-07-01
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Provider Licenses
StateLicense IDTaxonomies
VA0116019461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00944921OtherRAILROAD MEDICARE
VA1427219674Medicaid
541663754OtherCVFP INC
VA1427219674Medicaid