1942257365 NPI number — MS. CAROL ANN PITTMAN MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942257365 NPI number — MS. CAROL ANN PITTMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITTMAN
Provider First Name:
CAROL
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEARNS, STERNS-BOMAR, BOMAR
Provider Other First Name:
CAROL
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942257365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10051 5TH ST N
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SAINT PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33702-2289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-828-2412
Provider Business Mailing Address Fax Number:
727-568-6011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10051 5TH ST N
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SAINT PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33702-2289
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-828-2412
Provider Business Practice Location Address Fax Number:
727-568-6011
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME70510 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 277963300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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