MEDICARE: CHARLES N WITTEN MD

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	208800000X	Urology Physician	ME0057403	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10292	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	340003010	OTHER	FL	MDCR RAILROAD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376518431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES N WITTEN MD

Provider Business Mailing Address
First Line	:	4106 W LAKE MARY BLVD STE 215
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3344
Country	:	US
Telephone Number	:	407-332-7700
Fax Number	:	321-275-0339

Provider Business Practice Location Address
First Line	:	4106 W LAKE MARY BLVD STE 215
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3344
Country	:	US
Telephone Number	:	407-332-7700
Fax Number	:	321-275-0339

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	03/17/2018

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