Provider Demographics
NPI:1104161686
Name:CHITTENDEN, EDITH ANNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:ANNE
Last Name:CHITTENDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1800 ORLEANS ST
Mailing Address - Street 2:SHEIKH ZAYED TOWER 7107
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0010
Mailing Address - Country:US
Mailing Address - Phone:410-614-2210
Mailing Address - Fax:
Practice Address - Street 1:311 MACK AVE STE 64100
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2466
Practice Address - Country:US
Practice Address - Phone:313-832-0303
Practice Address - Fax:313-745-9222
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2019-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant