Healthcare Provider Details

I. General information

NPI: 1114998101
Provider Name (Legal Business Name): GEORGE WITTENBERG MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/07/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY DR BLDG. 1, 10 EAST, RM 133
PITTSBURGH PA
15240
US

IV. Provider business mailing address

3471 5TH AVE STE 811
PITTSBURGH PA
15213-3232
US

V. Phone/Fax

Practice location:
  • Phone: 412-360-6185
  • Fax: 412-360-6920
Mailing address:
  • Phone: 412-648-4178
  • Fax: 412-383-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberD0055622
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License NumberMD463447
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD463447
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: