Provider Demographics
NPI:1598951949
Name:CARL C GITTENS MD PA
Entity Type:Organization
Organization Name:CARL C GITTENS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:C
Authorized Official - Last Name:GITTENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-215-5905
Mailing Address - Street 1:611 SW FEDERAL HWY STE E
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2925
Mailing Address - Country:US
Mailing Address - Phone:772-288-4111
Mailing Address - Fax:772-905-3336
Practice Address - Street 1:611 SW FEDERAL HWY STE E
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2925
Practice Address - Country:US
Practice Address - Phone:772-288-4111
Practice Address - Fax:772-905-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty