Provider Demographics
NPI:1760558969
Name:PITTMAN, DONNA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:1221 MERCANTILE LANE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5374
Practice Address - Country:US
Practice Address - Phone:301-618-5638
Practice Address - Fax:301-618-5673
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD25623208600000X
VA0101032300208600000X
DCMD12447208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E22191Medicare UPIN
013604K92Medicare ID - Type Unspecified