Healthcare Provider Details

I. General information

NPI: 1073686671
Provider Name (Legal Business Name): SUSAN J WITTMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 ELLICOTT ST
BUFFALO NY
14203-1021
US

IV. Provider business mailing address

67 OLDE COVINGTON WAY
ARDEN NC
28704-9310
US

V. Phone/Fax

Practice location:
  • Phone: 443-895-1038
  • Fax:
Mailing address:
  • Phone: 443-895-1038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number266904
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number60201
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number60201
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number266904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: