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General NPI Number Information
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NPI Number | 1982706032
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Entity Type | Individual
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Provider Name | JOHN GERALD PITEGOFF MD
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 1225 SILVER ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3920
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Country | US
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Telephone | 860-638-2620
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Fax | 860-638-2630
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Provider Business Mailing Address
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Address Line | 20 HIGH POINT LN
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1135
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Country | US
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Telephone | 860-232-3314
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Fax | 860-232-1867
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 026828
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License Number State | CT
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