Provider Demographics
NPI:1366502452
Name:PITTONI CONDON, ANN ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:PITTONI CONDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:E
Other - Last Name:CONDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-2312
Mailing Address - Fax:
Practice Address - Street 1:269 GILLMAN RD STE 200A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7922
Practice Address - Country:US
Practice Address - Phone:704-316-5287
Practice Address - Fax:704-316-5268
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01867208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910292Medicaid
NC1366502452Medicaid
NC1366502452Medicaid