Healthcare Provider Details

I. General information

NPI: 1275695108
Provider Name (Legal Business Name): LORI D. WITCHER M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SEVENTH AVE
BOWLING GREEN KY
42101
US

IV. Provider business mailing address

1709 BRIAR CIR
BOWLING GREEN KY
42103-6222
US

V. Phone/Fax

Practice location:
  • Phone: 270-783-3573
  • Fax:
Mailing address:
  • Phone: 270-783-0190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36936
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: