MEDICARE: MS. DAMARIS EDMONSTONE PITTMAN LM, CPM

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
1	176B00000X	Midwife	LMW15	SC

General Provider Information

NPI Number	:	1386858017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAMARIS EDMONSTONE PITTMAN LM, CPM

Provider Business Mailing Address
First Line	:	7024 QUEENSBERRY DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-7657
Country	:	US
Telephone Number	:	704-542-9656
Fax Number	:

Provider Business Practice Location Address
First Line	:	7024 QUEENSBERRY DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-7657
Country	:	US
Telephone Number	:	704-542-9656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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