Provider Demographics
NPI:1528117173
Name:PITTEL, ELLIOT M (MD)
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:M
Last Name:PITTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:BUILDING #9
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:617-254-0964
Mailing Address - Fax:617-254-5539
Practice Address - Street 1:77 WARREN ST
Practice Address - Street 2:BUILDING #9 C HILDRENS COLLABORATIVE
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3601
Practice Address - Country:US
Practice Address - Phone:617-254-0964
Practice Address - Fax:617-254-5539
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA539142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6189776Medicaid
MA6189776Medicaid