Provider Demographics
NPI:1891798724
Name:WITTMAN, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:WITTMAN
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 1:10 BRAMBLEBUSH PARK
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2325
Mailing Address - Country:US
Mailing Address - Phone:508-540-1046
Mailing Address - Fax:
Practice Address - Street 1:10 BRAMBLEBUSH PARK
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2325
Practice Address - Country:US
Practice Address - Phone:508-540-1046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00067055OtherRAIL ROAD MEDICARE
MA6251OtherHARVARD PILGRIM
MA376898OtherPRIVATE HEALTHCARE SYSTEM
MA715096OtherTUFTS HEALTH PLAN
MAM18254OtherBLUE CROSS BLUE SHIELD
MA0402434OtherUNITED HEALTHCARE
MA3256423OtherAETNA
MA6195016Medicaid
MA6195016Medicaid
MA6251OtherHARVARD PILGRIM
MA6195016Medicaid