Provider Demographics
NPI:1194726612
Name:WITTENBERG, PETER H (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
Last Name:WITTENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1760 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0220
Mailing Address - Country:US
Mailing Address - Phone:704-834-2851
Mailing Address - Fax:704-834-2815
Practice Address - Street 1:2525 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2140
Practice Address - Country:US
Practice Address - Phone:704-834-2851
Practice Address - Fax:704-834-2815
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22866207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCCA2479Medicare UPIN
NC22373458Medicare ID - Type Unspecified