Provider Demographics
NPI:1588921787
Name:PETTIT, CLINT SPENSER (MD)
Entity type:Individual
Prefix:DR
First Name:CLINT
Middle Name:SPENSER
Last Name:PETTIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:110 IRVING ST. NW
Mailing Address - Street 2:EAST BLDG., ROOM 8122
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010
Mailing Address - Country:US
Mailing Address - Phone:202-877-7445
Mailing Address - Fax:202-877-0002
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:EAST BLDG., ROOM 8122
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-877-7445
Practice Address - Fax:202-877-0002
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD042935207RH0002X
VA0101257988207R00000X
MDD79721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine