Provider Demographics
NPI:1174699235
Name:WITMER, E JAMES (MD)
Entity type:Individual
Prefix:
First Name:E
Middle Name:JAMES
Last Name:WITMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3722
Mailing Address - Country:US
Mailing Address - Phone:330-478-0038
Mailing Address - Fax:330-477-1383
Practice Address - Street 1:1826 S ARCH AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4332
Practice Address - Country:US
Practice Address - Phone:330-823-7311
Practice Address - Fax:330-823-6344
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-4033208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0197077Medicaid
OHD31925Medicare UPIN