Provider Demographics
NPI:1407834880
Name:PITT, RICHARD L (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:PITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1308
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-0308
Mailing Address - Country:US
Mailing Address - Phone:330-928-4970
Mailing Address - Fax:330-928-4977
Practice Address - Street 1:1037 N MAIN ST
Practice Address - Street 2:STE B
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-1450
Practice Address - Country:US
Practice Address - Phone:330-928-4970
Practice Address - Fax:330-928-4977
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006290207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRI4027951OtherMEDICARE ID
OH2092524Medicaid
OHG15509Medicare UPIN
OH4027951Medicare PIN