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General NPI Number Information
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NPI Number | 1447576145
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Entity Type | Organization
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Legal Business Name | CHARLES B. WITT, JR MD INC
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 316 NORTH ROSSMORE AVENUE SUITE 507
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City | LOS ANGELES
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State | CA
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Zip | 90004-2415
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Country | US
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Telephone | 323-466-7333
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Fax | 323-871-1696
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Provider Business Mailing Address
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Address Line | 316 NORTH ROSSMORE AVENUE SUITE 507
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City | LOS ANGELES
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State | CA
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Zip | 90004-2415
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Country | US
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Telephone | 323-466-7333
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Fax | 323-871-1696
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES BENJAMIN WITT JR.
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Credential | M.D.
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Telephone | 323-466-7333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G3366
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | G3366
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G3366
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License Number State | CA
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