Healthcare Provider Details

I. General information

NPI: 1457732299
Provider Name (Legal Business Name): DEBORAH I WITKIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325A KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4517
US

IV. Provider business mailing address

325A KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4517
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-2731
  • Fax: 207-873-1106
Mailing address:
  • Phone: 207-873-2731
  • Fax: 207-873-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD22945
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: