Provider Demographics
NPI:1134271141
Name:DICKSON WITMER ASSOCIATES
Entity type:Organization
Organization Name:DICKSON WITMER ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON WITMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-656-1882
Mailing Address - Street 1:1504 N BROOM ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3087
Mailing Address - Country:US
Mailing Address - Phone:302-656-1882
Mailing Address - Fax:
Practice Address - Street 1:1504 N BROOM ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3087
Practice Address - Country:US
Practice Address - Phone:302-656-1882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-002159208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000256602Medicaid
DE050407Medicare ID - Type UnspecifiedGROUP#