Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D0080458 | MD |
Y | 111NI0900X | Internist | D0080458 | MD |
NPI | 1003040726 |
---|---|
Provider Name | Dr. Stephen John Witanowski |
First Address | Baltimore, MD 21209-3742 |
Second Address | Baltimore, MD 21209-3742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2009 |
Last Update Date | 25/01/2016 |