Healthcare Provider Details

I. General information

NPI: 1831707843
Provider Name (Legal Business Name): WITTING MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 THOMAS JOHNSON DR
FREDERICK MD
21702-4734
US

IV. Provider business mailing address

64 THOMAS JOHNSON DR
FREDERICK MD
21702-4734
US

V. Phone/Fax

Practice location:
  • Phone: 571-214-6550
  • Fax:
Mailing address:
  • Phone: 571-214-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC ALLELY
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 571-214-6550