Provider Demographics
NPI:1770698151
Name:PITTS, CHARLES MARK (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MARK
Last Name:PITTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:98-1079 MOANALUA RD
Mailing Address - Street 2:LABORATORY
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4713
Mailing Address - Country:US
Mailing Address - Phone:808-485-4517
Mailing Address - Fax:808-485-4381
Practice Address - Street 1:98-1079 MOANALUA RD
Practice Address - Street 2:LABORATORY
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4713
Practice Address - Country:US
Practice Address - Phone:808-485-4517
Practice Address - Fax:808-485-4381
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD7894207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD789401OtherQUEENS
HI4857501Medicaid
HIA55283OtherHMSA
ID52923Medicare ID - Type Unspecified
HIA55283OtherHMSA