Provider Demographics
NPI:1164649687
Name:PITTS, ANDREW TODD (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:TODD
Last Name:PITTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE ML 2008
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-663-6796
Mailing Address - Fax:513-636-7967
Practice Address - Street 1:3333 BURNET AVE ML 2008
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-663-6796
Practice Address - Fax:513-636-7967
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47199208000000X
CODR.00471992080P0204X
OH34.015260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95029567Medicaid
CO95029567Medicaid