Provider Demographics
NPI:1245658517
Name:PITT, RONALD ANDRE (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:ANDRE
Last Name:PITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 W LANCASTER AVE
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3337
Mailing Address - Country:US
Mailing Address - Phone:917-825-1870
Mailing Address - Fax:
Practice Address - Street 1:853 W LANCASTER AVE
Practice Address - Street 2:FLOOR 2
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3337
Practice Address - Country:US
Practice Address - Phone:917-825-1870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT2096762085R0202X
NMMD2019-02492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology