Provider Demographics
NPI:1780666388
Name:DEWITTE, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:DEWITTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5211 SPRING BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-3048
Mailing Address - Country:US
Mailing Address - Phone:317-460-1940
Mailing Address - Fax:
Practice Address - Street 1:3025 HAMAKER CT STE 350
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2243
Practice Address - Country:US
Practice Address - Phone:703-573-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101275603207Q00000X
TXN9039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200169350Medicaid
P01205501OtherRRMC
TX287935502Medicaid
IN200169350AMedicaid
G72682Medicare UPIN
IN200169350AMedicaid
IN940070Medicare PIN
187350DMedicare ID - Type Unspecified