Healthcare Provider Details

I. General information

NPI: 1013576545
Provider Name (Legal Business Name): JESSICA ANNE WITTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ANNE SWETLAND

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 02/11/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MAIN ST
OLEAN NY
14760-1500
US

IV. Provider business mailing address

535 MAIN ST
OLEAN NY
14760-1500
US

V. Phone/Fax

Practice location:
  • Phone: 716-372-0141
  • Fax:
Mailing address:
  • Phone: 716-376-2390
  • Fax: 716-376-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number316521
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: