Provider Demographics
NPI:1124062435
Name:PITTS, TANYA Y (MD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:Y
Last Name:PITTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 W INDIAN SCHOOL RD STE 127
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-2388
Mailing Address - Country:US
Mailing Address - Phone:623-931-3028
Mailing Address - Fax:623-931-3029
Practice Address - Street 1:9150 W INDIAN SCHOOL RD STE 127
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2388
Practice Address - Country:US
Practice Address - Phone:623-931-3028
Practice Address - Fax:623-931-3028
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30967208000000X
AZ43186208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200304570Medicaid