Provider Demographics
NPI:1548284326
Name:DEWITTY, ROBERT LEE JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:DEWITTY
Suffix:JR
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 1:7525 PEPPERELL DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-4653
Mailing Address - Country:US
Mailing Address - Phone:301-469-7941
Mailing Address - Fax:301-767-7934
Practice Address - Street 1:11721 WOODMORE RD
Practice Address - Street 2:SUITE # 100
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-4117
Practice Address - Country:US
Practice Address - Phone:301-218-1700
Practice Address - Fax:301-767-7934
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
MDD0015310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C62646Medicare UPIN
412371Medicare ID - Type Unspecified