Provider Demographics
NPI:1952342644
Name:WITT, MARY HELEN (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HELEN
Last Name:WITT
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:57 BEAM LN STE 300
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2350
Practice Address - Country:US
Practice Address - Phone:540-213-2220
Practice Address - Fax:540-213-2225
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057399207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1952342644Medicaid
VA97224OtherOPTIMA
VA010170648Medicaid
VA1000870001OtherDME PROVIDER
178278OtherANTHEM/BCBS
311669OtherSOUTHERN HEALTH
VA6832255OtherCIGNA
007936R74Medicare ID - Type Unspecified
VA007936R74Medicare PIN
WV3810002944OtherWV MEDICAID
I34000Medicare UPIN