Provider Demographics
NPI:1356384382
Name:WITMER, ELVIN D (MD)
Entity type:Individual
Prefix:DR
First Name:ELVIN
Middle Name:D
Last Name:WITMER
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 1:571 TERRACE BLVD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-3610
Mailing Address - Country:US
Mailing Address - Phone:716-683-4196
Mailing Address - Fax:716-646-0763
Practice Address - Street 1:571 TERRACE BLVD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-3610
Practice Address - Country:US
Practice Address - Phone:716-683-4196
Practice Address - Fax:716-646-0763
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2104211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01886039Medicaid
NY080134287OtherRAILROAD MEDICARE
NY000525241003OtherBLUE SHIELD WNY
NY00020022602OtherUNIVERA HEALTHCARE
NY0191742OtherINDEPENDENT HEALTH ASSOC
NY01886039Medicaid
NYE64073Medicare UPIN