Provider Demographics
NPI:1255434445
Name:S GOLDMAN MD C PITARYS MD PL
Entity type:Organization
Organization Name:S GOLDMAN MD C PITARYS MD PL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PITARYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-849-8771
Mailing Address - Street 1:14100 FIVAY ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7159
Mailing Address - Country:US
Mailing Address - Phone:727-849-8771
Mailing Address - Fax:727-842-4962
Practice Address - Street 1:14100 FIVAY RD STE 110
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7159
Practice Address - Country:US
Practice Address - Phone:727-849-8771
Practice Address - Fax:727-842-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45944OtherBCBS
FL262224600Medicaid
FLCH7540OtherRR MCR
FL45944OtherBCBS
FL=========OtherTRICARE
E14473Medicare UPIN
FLK2933Medicare PIN
FL45944OtherBCBS
FLK2933AMedicare PIN