Healthcare Provider Details

I. General information

NPI: 1003861360
Provider Name (Legal Business Name): GERALD W. DEWITT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4038 THOMAS NELSON HWY
ARRINGTON VA
22922
US

IV. Provider business mailing address

4038 THOMAS NELSON HWY
ARRINGTON VA
22922
US

V. Phone/Fax

Practice location:
  • Phone: 434-263-4000
  • Fax: 434-263-4160
Mailing address:
  • Phone: 434-263-4000
  • Fax: 434-263-4160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101019845
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: