Individual
MR. BRADLEY THOMAS DEWITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1780 HANSHAW RD, ITHACA, NY 14850-9105
(315) 283-3608
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
024437
NY
Other
Enumeration date
09/25/2019
Last updated
03/24/2021
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