Provider Demographics
NPI:1679506935
Name:PAUL J WITT MD
Entity Type:Organization
Organization Name:PAUL J WITT MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-823-7643
Mailing Address - Street 1:59 E CAREY ST
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-2007
Mailing Address - Country:US
Mailing Address - Phone:570-823-7643
Mailing Address - Fax:
Practice Address - Street 1:59 E CAREY ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-2007
Practice Address - Country:US
Practice Address - Phone:570-823-7643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039663-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA071516Medicare ID - Type Unspecified