Healthcare Provider Details

I. General information

NPI: 1770640799
Provider Name (Legal Business Name): THOMAS G DEWITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 11/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 2011
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML 2011
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4506
  • Fax: 513-636-7247
Mailing address:
  • Phone: 513-636-4506
  • Fax: 513-636-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.068516
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: