Provider Demographics
NPI:1194797076
Name:WITTIG, ALEXANDER H (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:H
Last Name:WITTIG
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:PO BOX 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-403-1331
Mailing Address - Fax:704-403-2533
Practice Address - Street 1:920 CHURCH ST N
Practice Address - Street 2:SUITE 255B
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2927
Practice Address - Country:US
Practice Address - Phone:704-403-1331
Practice Address - Fax:704-403-2533
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401154208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891370CMedicaid
NC1194797076Medicaid
NC2033268AOtherMEDICARE PTAN
SCNC1996Medicaid
NCNCG222AMedicare PIN
NC891370CMedicaid
NCNCG222C904Medicare PIN
NC2033268AOtherMEDICARE PTAN