NPIMap

Organization Active NPI

Robert Van Wittenberghe,MD,LLC

  • Psychiatry Physician
  • Lynn, MA
National Provider Identifier
1114206000
Registry record updated Aug 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
40259 Issued in MA
Legal business name
ROBERT VAN WITTENBERGHE,MD,LLC
Practice address
330 Lynnway
Suite 101
Lynn, MA 01901-1706
Phone
(781) 595-3003
Fax
(781) 593-0071
NPI assigned
Aug 9, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert Jules Van Wittenberghe, M.D.
Title
President
Phone
(781) 595-3003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 40259 MA Primary

Addresses

Primary practice location

330 Lynnway
Suite 101
Lynn, MA 01901-1706

Mailing address

330 Lynnway
Suite 101
Lynn, MA 01901-1706
Phone (781) 595-3003

Other identifiers 1

IdentifierTypeStateIssuer
2066874MedicaidMA

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312848000000",
    "number": "1114206000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 LYNNWAY",
            "address_2": "SUITE 101",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019011706",
            "telephone_number": "781-595-3003",
            "fax_number": "781-593-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 LYNNWAY",
            "address_2": "SUITE 101",
            "city": "LYNN",
            "state": "MA",
            "postal_code": "019011706",
            "telephone_number": "781-595-3003",
            "fax_number": "781-593-0071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT VAN WITTENBERGHE,MD,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-09",
        "last_updated": "2011-08-09",
        "status": "A",
        "authorized_official_last_name": "VAN WITTENBERGHE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JULES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-595-3003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "40259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2066874",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynn, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.