1760691208 NPI number — DR. ANGELA RUTH PITTS O.D.

Table of content: DR. ANGELA RUTH PITTS O.D. (NPI 1760691208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760691208 NPI number — DR. ANGELA RUTH PITTS O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PITTS
Provider First Name:
ANGELA
Provider Middle Name:
RUTH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AUGUST
Provider Other First Name:
ANGELA
Provider Other Middle Name:
PITTS
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760691208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
149 CRAIN HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER MARLBORO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20774-8804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-514-7707
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1328 SOUTHERN AVE SE
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20032-4689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-538-1220
Provider Business Practice Location Address Fax Number:
202-574-1674
Provider Enumeration Date:
05/22/2007

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: 152W00000X , with the licence number:  OPC2835 , 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: OP 1000184 . This is a "OPTOMETRY LISCENSE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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