Provider Demographics
NPI:1790946200
Name:WITTMAN, LORI MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MARIE
Last Name:WITTMAN
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 1:119 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2868
Mailing Address - Country:US
Mailing Address - Phone:828-771-5537
Mailing Address - Fax:
Practice Address - Street 1:2525 N 8TH ST
Practice Address - Street 2:STE 202
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8847
Practice Address - Country:US
Practice Address - Phone:970-986-8900
Practice Address - Fax:970-233-7769
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR51835207V00000X
CO0051635207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology