Provider Demographics
NPI:1457732299
Name:WITKIN, DEBORAH I (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:I
Last Name:WITKIN
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 1:325A KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4517
Mailing Address - Country:US
Mailing Address - Phone:207-873-2731
Mailing Address - Fax:207-873-1106
Practice Address - Street 1:325A KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4517
Practice Address - Country:US
Practice Address - Phone:207-873-2731
Practice Address - Fax:207-873-1106
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD22945207W00000X
NMRS2018-0731390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program