Provider Demographics
NPI:1942257365
Name:PITTMAN, CAROL ANN (MD)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:STEARNS, STERNS-BOMAR, BOMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10051 5TH ST N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2289
Mailing Address - Country:US
Mailing Address - Phone:727-828-2412
Mailing Address - Fax:727-568-6011
Practice Address - Street 1:10051 5TH ST N
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2289
Practice Address - Country:US
Practice Address - Phone:727-828-2412
Practice Address - Fax:727-568-6011
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277963300Medicaid
FL277963300Medicaid
FLG54061Medicare UPIN