Provider Demographics
NPI:1578616918
Name:WYTTENBACH, ANN (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:WYTTENBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-5213
Mailing Address - Country:US
Mailing Address - Phone:704-366-1215
Mailing Address - Fax:
Practice Address - Street 1:901 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-5213
Practice Address - Country:US
Practice Address - Phone:704-366-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2186360NMedicare PIN
NC2186360SMedicare PIN
NC2186360HMedicare PIN
NC2186360PMedicare PIN
NC2186360UMedicare PIN
NC2186360JMedicare PIN
NC2186360MMedicare PIN
NC2186360FMedicare PIN
NC2186360RMedicare PIN
NC2186360TMedicare PIN
NC2186360GMedicare PIN
NC2186360KMedicare PIN
NC2186360VMedicare PIN