Provider Demographics
NPI:1982376679
Name:PITTMAN, LOIS M
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:M
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 LAUREL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28679-9520
Mailing Address - Country:US
Mailing Address - Phone:828-773-6851
Mailing Address - Fax:
Practice Address - Street 1:2165 LAUREL CREEK RD
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:NC
Practice Address - Zip Code:28679-9520
Practice Address - Country:US
Practice Address - Phone:828-773-6851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPITT-5AA0P207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine