Provider Demographics
NPI:1922282235
Name:STEPHEN R. PITTMAN, DPM PA
Entity Type:Organization
Organization Name:STEPHEN R. PITTMAN, DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PITTMAN, DPM PA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:302-368-5000
Mailing Address - Street 1:410 CHRISTIANA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-1654
Mailing Address - Country:US
Mailing Address - Phone:302-368-5000
Mailing Address - Fax:302-368-9026
Practice Address - Street 1:410 CHRISTIANA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-1654
Practice Address - Country:US
Practice Address - Phone:302-368-5000
Practice Address - Fax:302-368-9026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000070213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
177118OtherUNITED HEALTH CARE
35024901OtherBS MARYLAN
4368618OtherAETNA
DE0000148350Medicaid
512066757OtherBS DELAWARE
210674OtherALLIANCE
1466337OtherCIGNA
210674OtherOPTIMUM CHOICE
118862Medicare PIN
210674OtherALLIANCE