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NPI Code Detail

MEDICARE: NANCY WITHAM M.D.

MEDICARE:   NANCY  WITHAM  M.D.
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
1208000000XPediatrics PhysicianME63344FL

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 : 1770585796
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY WITHAM M.D.
Provider Business Mailing Address
First Line : PO BOX 70
Second Line :
City : LABELLE
State : FL
Zip : 33975-0070
Country : US
Telephone Number : 863-674-4041
Fax Number :
Provider Business Practice Location Address
First Line : 1140 PRATT BLVD
Second Line :
City : LABELLE
State : FL
Zip : 33935-4405
Country : US
Telephone Number : 863-674-4041
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 10/01/2021

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Directions to “ NANCY WITHAM M.D.” Practice Location

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