Provider Demographics
NPI:1699986190
Name:PITA DE OLIVEIRA, LUIZ OTAVIO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIZ
Middle Name:OTAVIO
Last Name:PITA DE OLIVEIRA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CAROMONT HEMATOLOGY AND ONCOLOGY
Mailing Address - Street 2:2711 X-RAY DRIVE
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054
Mailing Address - Country:US
Mailing Address - Phone:980-834-9600
Mailing Address - Fax:980-834-9605
Practice Address - Street 1:CAROMONT HEMATOLOGY AND ONCOLOGY
Practice Address - Street 2:2711 X-RAY DRIVE
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:980-834-9600
Practice Address - Fax:980-834-9605
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137314207RX0202X
NC2021-01297207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100395800Medicaid