Healthcare Provider Details

I. General information

NPI: 1043200314
Provider Name (Legal Business Name): ARTHUR CLIFFORD WITTICH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 FARRELL RD OB/GYN SERVICE
FORT BELVOIR VA
22060-5901
US

IV. Provider business mailing address

6725 CATSKILL RD
LORTON VA
22079-1113
US

V. Phone/Fax

Practice location:
  • Phone: 703-805-0813
  • Fax: 703-805-0875
Mailing address:
  • Phone: 703-541-4077
  • Fax: 703-805-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number33699
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: