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Organization
PENINSULA PLASTIC SURGERY CENTER
Active
Organization
PENINSULA PLASTIC SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN M. PITMAN III M.D. (PHYSICIAN)
(757) 229-5200
Entity
Organization
Contact information
Practice address
324 MONTICELLO AVE, WILLIAMSBURG, VA 23185-2834
(757) 229-5200
(757) 229-2692
Mailing address
324 MONTICELLO AVE, WILLIAMSBURG, VA 23185-2834
(757) 229-5200
(757) 229-2692
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101052484
VA
208200000X
Plastic Surgery Physician
—
NULL
208200000X
Plastic Surgery Physician
—
—
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
—
NULL
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007601328
—
VA
01
—
121242
SOUTHERN HEALTH
VA
01
—
140457
ANTHEM
VA
01
—
213427
CIGNA
VA
01
—
432612
UNITED HEALTHCARE
VA
01
—
5209080
AETNA
VA
01
—
54536
SENTARA OPTIMA
VA
01
—
620043172
RAILROAD MEDICARE
VA
Enumeration date
01/03/2007
Last updated
12/11/2020
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