Provider Demographics
NPI:1639130768
Name:WITMER, LAWRENCE J (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:WITMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:20800 HARVARD RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7251
Mailing Address - Country:US
Mailing Address - Phone:330-954-7210
Mailing Address - Fax:330-954-7211
Practice Address - Street 1:55 N CHILLICOTHE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8798
Practice Address - Country:US
Practice Address - Phone:330-954-7210
Practice Address - Fax:330-954-7211
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34-006994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000339426OtherANTHEM
OHO1811271Medicaid
OH000000339426OtherANTHEM
OH4023172Medicare PIN