Healthcare Provider Details

I. General information

NPI: 1639137706
Provider Name (Legal Business Name): ANTHONY J WITTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 TOWNE AVE
PLAINFIELD VT
05667-9425
US

IV. Provider business mailing address

10869 RTE 36 SOUTH PO BOX 601
DANSVILLE NY
14437-0601
US

V. Phone/Fax

Practice location:
  • Phone: 802-454-8336
  • Fax: 802-454-8339
Mailing address:
  • Phone: 585-335-3416
  • Fax: 585-335-8695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number169902
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number169902
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042.0016083
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: