Basic Information
Provider Information
NPI: 1417963992
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEWITT
FirstName: AARON
MiddleName: G.
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 E PENN SQ
Address2: 9TH FLOOR NORTH TOWER
City: PHILADELPHIA
State: PA
PostalCode: 191073323
CountryCode: US
TelephoneNumber: 2674259200
FaxNumber: 2674259298
Practice Location
Address1: 3401 CIVIC CENTER BLVD
Address2: CHILDRENS HOSPITAL OF PHILADELPHIA
City: PHILADELPHIA
State: PA
PostalCode: 191044319
CountryCode: US
TelephoneNumber: 2155904040
FaxNumber: 2674269800
Other Information
ProviderEnumerationDate: 08/01/2006
LastUpdateDate: 07/21/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0202XMD451518PAY Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology

No ID Information.


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