Provider Demographics
NPI:1811995806
Name:PITTS, ELEANOR C (MD)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:C
Last Name:PITTS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:340 MAIN ST
Mailing Address - Street 2:STE. 670
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1604
Mailing Address - Country:US
Mailing Address - Phone:508-754-3566
Mailing Address - Fax:508-438-6364
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:SUITE 5790
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-522-0008
Practice Address - Fax:617-522-2587
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-10-04
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Provider Licenses
StateLicense IDTaxonomies
MA812742086S0122X, 208200000X, 2082S0099X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3145387Medicaid
MA3145387Medicaid
E89925Medicare UPIN