Provider Demographics
NPI:1619953064
Name:PITT, DARRELL MARTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:MARTIN
Last Name:PITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3444 MCKELVEY RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2525
Mailing Address - Country:US
Mailing Address - Phone:314-291-6224
Mailing Address - Fax:314-291-7346
Practice Address - Street 1:3444 MCKELVEY RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2525
Practice Address - Country:US
Practice Address - Phone:314-291-6224
Practice Address - Fax:314-291-7346
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6165208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D41518Medicare UPIN