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NPI Code Detail

MEDICARE: DR. SAMUEL H WITTENBERG MD

MEDICARE: DR. SAMUEL H WITTENBERG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician0101041639VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558336941
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SAMUEL H WITTENBERG MD
Provider Business Mailing Address
First Line : 5000 COX RD
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-9263
Country : US
Telephone Number : 804-968-5700
Fax Number :
Provider Business Practice Location Address
First Line : 3432 HOLLAND RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-4846
Country : US
Telephone Number : 757-468-1855
Fax Number : 757-468-4441
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2006
Last Update Date : 04/14/2022

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