Healthcare Provider Details

I. General information

NPI: 1518925247
Provider Name (Legal Business Name): THOMAS A PITTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST MS 106
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

800 ROSE ST MS 106
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5661
  • Fax: 859-257-1532
Mailing address:
  • Phone: 859-323-5661
  • Fax: 859-257-1532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35708
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: