MEDICARE: ROBERT LEE DEWITTY JR. 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	174400000X	Specialist
2	174400000X	Specialist	D0015310	MD

General Provider Information

NPI Number	:	1548284326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT LEE DEWITTY JR. M.D.

Provider Business Mailing Address
First Line	:	7525 PEPPERELL DR
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-4653
Country	:	US
Telephone Number	:	301-469-7941
Fax Number	:	301-767-7934

Provider Business Practice Location Address
First Line	:	11721 WOODMORE RD
Second Line	:	SUITE # 100
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-4117
Country	:	US
Telephone Number	:	301-218-1700
Fax Number	:	301-767-7934

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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