Provider Demographics
NPI:1639130768
Name:WITMER, LAWRENCE J (DO)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:J
Last Name:WITMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:J
Other - Last Name:WITMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:34055 SOLON RD # 111B
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2662
Mailing Address - Country:US
Mailing Address - Phone:440-914-7204
Mailing Address - Fax:440-502-2183
Practice Address - Street 1:34055 SOLON RD # 111B
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2662
Practice Address - Country:US
Practice Address - Phone:440-914-7204
Practice Address - Fax:440-502-2183
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-006994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000339426OtherANTHEM
OHO1811271Medicaid
OH000000339426OtherANTHEM
OH4023172Medicare PIN