Healthcare Provider Details

I. General information

NPI: 1699986190
Provider Name (Legal Business Name): LUIZ OTAVIO PITA DE OLIVEIRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2406 CENTURY PL SE
HICKORY NC
28602-4031
US

IV. Provider business mailing address

PO BOX 3710
HICKORY NC
28603-3710
US

V. Phone/Fax

Practice location:
  • Phone: 828-324-9550
  • Fax: 828-324-4154
Mailing address:
  • Phone: 704-342-9577
  • Fax: 704-377-0353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD492689
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2021-01297
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: