Provider Demographics
NPI:1295039691
Name:CHRIS PITTMAN MD PA
Entity Type:Organization
Organization Name:CHRIS PITTMAN MD PA
Other - Org Name:VEIN911
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:C.
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-834-6911
Mailing Address - Street 1:1099 SHIPWATCH CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5736
Mailing Address - Country:US
Mailing Address - Phone:855-834-6911
Mailing Address - Fax:813-443-5600
Practice Address - Street 1:2815 W VIRGINIA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6357
Practice Address - Country:US
Practice Address - Phone:855-834-6911
Practice Address - Fax:813-443-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00647602085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4687430OtherAETNA
FLDW0684OtherMEDICARE RAILROAD
FL0088JOtherFL BLUE
FL01472670Medicaid
FL4687430OtherAETNA