MEDICARE: CHRISTOPHER V. PITCOCK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	28836	KY
2	207QS0010X	Sports Medicine (Family Medicine) Physician	28836	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000052204	OTHER	KY	ANTHEM BCBS

General Provider Information

NPI Number	:	1174566152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER V. PITCOCK M.D.

Provider Business Mailing Address
First Line	:	2700 STANLEY GAULT PKWY STE 129
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5176
Country	:	US
Telephone Number	:	502-489-6613
Fax Number	:	502-489-5751

Provider Business Practice Location Address
First Line	:	2400 EASTPOINT PKWY STE 110
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-4154
Country	:	US
Telephone Number	:	502-253-6699
Fax Number	:	502-253-6670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	11/02/2021

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