MEDICARE: DR. PAUL J WITT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	MD039663L	PA

General Provider Information

NPI Number	:	1154314888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J WITT M.D.

Provider Business Mailing Address
First Line	:	59 E CAREY ST
Second Line	:
City	:	PLAINS
State	:	PA
Zip	:	18705-2007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 E CAREY ST
Second Line	:
City	:	PLAINS
State	:	PA
Zip	:	18705-2007
Country	:	US
Telephone Number	:	570-823-7643
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	06/30/2010

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