Provider Demographics
NPI:1518921709
Name:WITTSTADT, RAYMOND A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:A
Last Name:WITTSTADT
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 1:1400 FRONT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5300
Mailing Address - Country:US
Mailing Address - Phone:410-296-6232
Mailing Address - Fax:410-821-5943
Practice Address - Street 1:1400 FRONT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5300
Practice Address - Country:US
Practice Address - Phone:410-296-6232
Practice Address - Fax:410-821-5943
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042198207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDE5302OtherRAILROAD MEDICARE
MD903AOtherCAREFIRST MARYLAND
MDJ848OtherCAREFIRST DC
MDDC8030OtherRAILROAD MEDICARE
MD331950400Medicaid
MDDC8030OtherRAILROAD MEDICARE
MD903AOtherCAREFIRST MARYLAND