Provider Demographics
NPI:1851899074
Name:BITTINGER, LES
Entity Type:Individual
Prefix:
First Name:LES
Middle Name:
Last Name:BITTINGER
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 1:118 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2141
Mailing Address - Country:US
Mailing Address - Phone:301-722-5500
Mailing Address - Fax:301-722-0500
Practice Address - Street 1:118 VALLEY ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2141
Practice Address - Country:US
Practice Address - Phone:301-722-5500
Practice Address - Fax:301-722-0500
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1083924518Medicaid