Provider Demographics
NPI:1770721318
Name:DEWITT, KRISTIN LIANE (MT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LIANE
Last Name:DEWITT
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 BRIDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4218
Mailing Address - Country:US
Mailing Address - Phone:856-296-8187
Mailing Address - Fax:609-257-6029
Practice Address - Street 1:414 STOKES RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8400
Practice Address - Country:US
Practice Address - Phone:856-296-8187
Practice Address - Fax:609-257-6029
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist