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NPI Code Detail

MEDICARE: MARK T. WITKOWSKI MD

MEDICARE:   MARK T. WITKOWSKI  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 Physician16996WV

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 : 1659366052
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK T. WITKOWSKI MD
Provider Business Mailing Address
First Line : 709 MAPLE AVE
Second Line :
City : GRAFTON
State : WV
Zip : 26354-1823
Country : US
Telephone Number : 304-265-4131
Fax Number : 304-265-6443
Provider Business Practice Location Address
First Line : 1 HOSPITAL PLZ
Second Line :
City : GRAFTON
State : WV
Zip : 26354-1283
Country : US
Telephone Number : 304-265-7406
Fax Number : 304-265-6443
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2005
Last Update Date : 03/05/2014

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Directions to “ MARK T. WITKOWSKI MD” Practice Location

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