MEDICARE: LOIS M. PITTMAN

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	PITT-5AA0P	NC

General Provider Information

NPI Number	:	1982376679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOIS M. PITTMAN

Provider Business Mailing Address
First Line	:	2165 LAUREL CREEK RD
Second Line	:
City	:	SUGAR GROVE
State	:	NC
Zip	:	28679-9520
Country	:	US
Telephone Number	:	828-773-6851
Fax Number	:

Provider Business Practice Location Address
First Line	:	2165 LAUREL CREEK RD
Second Line	:
City	:	SUGAR GROVE
State	:	NC
Zip	:	28679-9520
Country	:	US
Telephone Number	:	828-773-6851
Fax Number	:

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

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	09/30/2021

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