Healthcare Provider Details

I. General information

NPI: 1053236083
Provider Name (Legal Business Name): SAMUEL JOHN PITTENGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 FAIRFIELD RD
GETTYSBURG PA
17325-6309
US

IV. Provider business mailing address

2311 FAIRFIELD RD
GETTYSBURG PA
17325-6309
US

V. Phone/Fax

Practice location:
  • Phone: 717-398-2044
  • Fax:
Mailing address:
  • Phone: 717-398-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: