Provider Demographics
NPI:1770597536
Name:PITTMAN, ANNE MARIE (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:135 E MAXWELL ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2640
Mailing Address - Country:US
Mailing Address - Phone:859-323-5199
Mailing Address - Fax:859-323-1003
Practice Address - Street 1:135 E MAXWELL ST
Practice Address - Street 2:SUITE 250
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2640
Practice Address - Country:US
Practice Address - Phone:859-323-5199
Practice Address - Fax:859-323-1003
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36451207R00000X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64028046Medicaid
KY64028046Medicaid
0641374Medicare ID - Type Unspecified