Provider Demographics
NPI:1376990549
Name:PITTS, DARREN
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:
Last Name:PITTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12198 RIVERTON CT
Mailing Address - Street 2:
Mailing Address - City:REMINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22734-2173
Mailing Address - Country:US
Mailing Address - Phone:540-402-6490
Mailing Address - Fax:
Practice Address - Street 1:12198 RIVERTON CT
Practice Address - Street 2:
Practice Address - City:REMINGTON
Practice Address - State:VA
Practice Address - Zip Code:22734-2173
Practice Address - Country:US
Practice Address - Phone:540-402-6490
Practice Address - Fax:540-301-1450
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA17013172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver