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Individual

JACK T WITZENFELD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.

Contact information

Practice address
736 BATTLEFIELD BLVD N, CHESAPEAKE GENERAL HOSPITAL, CHESAPEAKE, VA 23320-4941
(757) 490-9388
(757) 490-9401
Mailing address
4536 BONNEY RD, VIRGINIA BEACH, VA 23462-3869
(757) 490-9388
(757) 490-9401

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110840299
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
970000664
MEDICARE RAILROAD
Enumeration date
09/08/2006
Last updated
11/05/2010
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