Healthcare Provider Details

I. General information

NPI: 1912993098
Provider Name (Legal Business Name): ELEANOR HINDS DE WITT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 N MAIN ST
PENN YAN NY
14527-1070
US

IV. Provider business mailing address

418 N MAIN ST
PENN YAN NY
14527-1070
US

V. Phone/Fax

Practice location:
  • Phone: 315-531-2944
  • Fax: 315-536-0430
Mailing address:
  • Phone: 315-531-2944
  • Fax: 315-536-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number155147
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: