Provider Demographics
NPI:1609924919
Name:PITTMAN, MARCUS L III (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:L
Last Name:PITTMAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARC
Other - Middle Name:
Other - Last Name:PITTMAN
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:307 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3135
Mailing Address - Country:US
Mailing Address - Phone:985-892-3661
Mailing Address - Fax:985-892-3372
Practice Address - Street 1:307 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3135
Practice Address - Country:US
Practice Address - Phone:985-892-3661
Practice Address - Fax:985-892-3372
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014891207P00000X, 208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB89268Medicare UPIN
LA5M773Medicare ID - Type Unspecified