Provider Demographics
NPI:1982191003
Name:WITTENBERG, BLAKE EDWARD (MD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:EDWARD
Last Name:WITTENBERG
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 1:1932 ALCOA HWY STE 360
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1509
Mailing Address - Country:US
Mailing Address - Phone:865-524-1869
Mailing Address - Fax:
Practice Address - Street 1:1932 ALCOA HWY STE 360
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1509
Practice Address - Country:US
Practice Address - Phone:865-524-1869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-14
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0066896207T00000X
TN73245207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery