Provider Demographics
NPI:1932178845
Name:WITTEN, BEROLD I (MD)
Entity Type:Individual
Prefix:
First Name:BEROLD
Middle Name:I
Last Name:WITTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:555 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-983-9000
Mailing Address - Fax:314-983-9023
Practice Address - Street 1:555 N NEW BALLAS RD STE 150
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6843
Practice Address - Country:US
Practice Address - Phone:314-983-9000
Practice Address - Fax:314-983-9023
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8523207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2542820OtherECFMG