Provider Demographics
NPI:1659576213
Name:WITTEN, EILEEN KIRSTEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:KIRSTEN
Last Name:WITTEN
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 1:2008 HINCKLEY HILLS RD
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9738
Mailing Address - Country:US
Mailing Address - Phone:440-525-0431
Mailing Address - Fax:
Practice Address - Street 1:201 5TH ST NE STE 6
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3017
Practice Address - Country:US
Practice Address - Phone:330-745-4748
Practice Address - Fax:330-745-4970
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.096403207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4311961OtherMEDICARE ID
OH3123088Medicaid