Provider Demographics
NPI:1467429076
Name:WITTMANN, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:WITTMANN
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 1:4382 WINNERS CIR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-6610
Mailing Address - Country:US
Mailing Address - Phone:814-833-1451
Mailing Address - Fax:
Practice Address - Street 1:3580 PEACH ST
Practice Address - Street 2:SUITE 103A
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2776
Practice Address - Country:US
Practice Address - Phone:814-864-4755
Practice Address - Fax:814-864-5430
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026724E207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00085577300002Medicaid
PA052402FR6Medicare PIN
PA052402HXKMedicare PIN
PA00085577300002Medicaid