Provider Demographics
NPI:1598233934
Name:PITSTOP HEALTHCARE LLC
Entity Type:Organization
Organization Name:PITSTOP HEALTHCARE LLC
Other - Org Name:HEALTH TRAVEL, IMMUNIZATIONS AND PHYSICALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:410-870-4847
Mailing Address - Street 1:3702 PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2118
Mailing Address - Country:US
Mailing Address - Phone:410-870-4847
Mailing Address - Fax:
Practice Address - Street 1:3702 PERRY AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2118
Practice Address - Country:US
Practice Address - Phone:410-870-4847
Practice Address - Fax:410-510-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-03
Last Update Date:2019-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty