Provider Demographics
NPI:1538164678
Name:CHITTY, MARC J (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:J
Last Name:CHITTY
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 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7718
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:50 MEDICAL PARK DR E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3401
Practice Address - Country:US
Practice Address - Phone:205-838-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL230832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938651Medicaid
AL051515359OtherBLUE CROSS
AL009938653Medicaid
AL009938654Medicaid
AL051515354OtherBLUE CROSS
AL009938648Medicaid
AL051515357OtherBLUE CROSS
AL051539871OtherBLUE CROSS
AL009938652Medicaid
AL009984395Medicaid
AL051515363OtherBLUE CROSS
AL7036555OtherAETNA
AL051515356OtherBLUE CROSS
AL051515358OtherBLUE CROSS
AL051525423OtherBLUE CROSS
AL051553495Medicaid
AL009938649Medicaid
AL051515361OtherBLUE CROSS
AL051515362OtherBLUE CROSS
AL051539871OtherBLUE CROSS
AL051525423OtherBLUE CROSS
ALH72054Medicare UPIN