Provider Demographics
NPI:1548362577
Name:WITTENBERG, MARTHA E (MD)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:E
Last Name:WITTENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:ALWORTH
Other - Last Name:EBERHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5855E NAPLES PLZ 307
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5091
Mailing Address - Country:US
Mailing Address - Phone:562-434-0650
Mailing Address - Fax:562-434-0641
Practice Address - Street 1:5855 E. 2ND STREET
Practice Address - Street 2:SUITE 307
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803
Practice Address - Country:US
Practice Address - Phone:310-266-7284
Practice Address - Fax:562-433-4342
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90355207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine