Provider Demographics
NPI:1568606747
Name:WITCHER, MARK RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RUSSELL
Last Name:WITCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DEPT. OF NEUROSURGERY, WAKE FOREST UNIVERSITY
Practice Address - Street 2:BAPTIST MEDICAL CENTER, MEDICAL CENTER BLVD.
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-7580
Practice Address - Country:US
Practice Address - Phone:336-341-3037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA073884207T00000X
VA0101260948207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery