Provider Demographics
NPI:1528046901
Name:RICHARD L. PITT, D.O.
Entity type:Organization
Organization Name:RICHARD L. PITT, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:PITT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-928-4970
Mailing Address - Street 1:PO BOX 1308
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-0308
Mailing Address - Country:US
Mailing Address - Phone:330-928-4970
Mailing Address - Fax:330-928-4977
Practice Address - Street 1:2250 BROAD BLVD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1412
Practice Address - Country:US
Practice Address - Phone:330-928-4970
Practice Address - Fax:330-928-4977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006290207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2092524Medicaid
OH2092524Medicaid
OHGI5509Medicare UPIN