Provider Demographics
NPI:1629269394
Name:PITTAOULIS, ANN B (RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:B
Last Name:PITTAOULIS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-4209
Mailing Address - Country:US
Mailing Address - Phone:215-745-5037
Mailing Address - Fax:215-537-8499
Practice Address - Street 1:1251 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-4209
Practice Address - Country:US
Practice Address - Phone:215-745-5037
Practice Address - Fax:215-537-8499
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000931133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered