Healthcare Provider Details

I. General information

NPI: 1861571762
Provider Name (Legal Business Name): MARY F. WITT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 EDWARD HOLLAND DR
RICHMOND VA
23230-2518
US

IV. Provider business mailing address

2221 EDWARD HOLLAND DR
RICHMOND VA
23230-2518
US

V. Phone/Fax

Practice location:
  • Phone: 804-354-2539
  • Fax:
Mailing address:
  • Phone: 804-354-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number0101042681
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: