Provider Demographics
NPI:1700836368
Name:PITT, HENRY ANTHONY
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:ANTHONY
Last Name:PITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 BARNHILL DR
Mailing Address - Street 2:EM 523
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:545 BARNHILL DR
Practice Address - Street 2:EM 523
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5112
Practice Address - Country:US
Practice Address - Phone:317-274-3086
Practice Address - Fax:317-278-1886
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1059833A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200507960Medicaid
IN233690BMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
IN200507960Medicaid