Provider Demographics
NPI:1093782419
Name:PITHA, NICHOLAS R (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:R
Last Name:PITHA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3604 N WELLS FARGO AVE
Mailing Address - Street 2:STE L
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5629
Mailing Address - Country:US
Mailing Address - Phone:480-947-7401
Mailing Address - Fax:480-946-5565
Practice Address - Street 1:3604 N WELLS FARGO AVE
Practice Address - Street 2:STE L
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5629
Practice Address - Country:US
Practice Address - Phone:480-947-7401
Practice Address - Fax:480-946-5565
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ5847208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ231845OtherAHCCCS
AZ231845OtherAHCCCS