Provider Demographics
NPI:1275635229
Name:PITMAN, JOHN M III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:PITMAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2834
Mailing Address - Country:US
Mailing Address - Phone:757-229-5200
Mailing Address - Fax:757-229-2692
Practice Address - Street 1:324 MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2834
Practice Address - Country:US
Practice Address - Phone:757-229-5200
Practice Address - Fax:757-229-2692
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052484208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA289669OtherANTHEM
VA140457OtherANTHEM
VA5209080OtherAETNA
VA213427OtherCIGNA
VA432612OtherMAMSI/ALLIANCE
VA121242OtherSOUTHERN HEALTH
VA54536OtherSENTARA/OPTIMA
VA620043172OtherRAILROAD MEDICARE
VA007601328Medicaid
VA541913625OtherTAX ID NUMBER
VAC06547Medicare PIN
VAE56323Medicare UPIN