Healthcare Provider Details

I. General information

NPI: 1275635229
Provider Name (Legal Business Name): JOHN M PITMAN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 12/28/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 MONTICELLO AVE
WILLIAMSBURG VA
23185-2834
US

IV. Provider business mailing address

324 MONTICELLO AVE
WILLIAMSBURG VA
23185-2834
US

V. Phone/Fax

Practice location:
  • Phone: 757-229-5200
  • Fax: 757-229-2692
Mailing address:
  • Phone: 757-229-5200
  • Fax: 757-229-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101052484
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: