Healthcare Provider Details

I. General information

NPI: 1962467548
Provider Name (Legal Business Name): BERNARD F WITTKAMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8710 CHOCTAW RD
RICHMOND VA
23235
US

IV. Provider business mailing address

8710 CHOCTAW RD
RICHMOND VA
23235
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-7431
  • Fax:
Mailing address:
  • Phone: 804-272-7431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number0101-012996
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: