MEDICARE: VIRGINIA ALICIA PITTMAN-WALLER 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	208200000X	Plastic Surgery Physician	K5666	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376593939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA ALICIA PITTMAN-WALLER M.D.

Provider Business Mailing Address
First Line	:	818 W 41ST STREET
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018
Country	:	US
Telephone Number	:	210-416-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 SOUTH LOOP WEST
Second Line	:	SUITE 210
City	:	HOUSTON
State	:	TX
Zip	:	77054
Country	:	US
Telephone Number	:	210-416-6000
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	12/15/2023

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