Provider Demographics
NPI:1861739153
Name:MARC PITTMAN, III, MD, LLC
Entity type:Organization
Organization Name:MARC PITTMAN, III, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER AND MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:L
Authorized Official - Last Name:PITTMAN,
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:985-892-3661
Mailing Address - Street 1:307 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3135
Mailing Address - Country:US
Mailing Address - Phone:985-892-3661
Mailing Address - Fax:985-892-3372
Practice Address - Street 1:2659 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6435
Practice Address - Country:US
Practice Address - Phone:985-898-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.014891208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty