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NPI Code Detail

MEDICARE: DR. JEFFREY DEAN PITTIS M.D.

MEDICARE: DR. JEFFREY DEAN PITTIS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianME013153ME

General Provider Information

NPI Number : 1023006194
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY DEAN PITTIS M.D.
Provider Business Mailing Address
First Line : 90 RIDGEWOOD DR
Second Line :
City : BANGOR
State : ME
Zip : 04401-2652
Country : US
Telephone Number : 207-942-0669
Fax Number : 207-947-3143
Provider Business Practice Location Address
First Line : 90 RIDGEWOOD DR
Second Line :
City : BANGOR
State : ME
Zip : 04401-2652
Country : US
Telephone Number : 207-942-0669
Fax Number : 207-947-3143
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2005
Last Update Date : 07/08/2007

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