Provider Demographics
NPI:1841279916
Name:PITTALUGA, JUAN (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:PITTALUGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 CEDAR CREEK GRADE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2706
Mailing Address - Country:US
Mailing Address - Phone:540-662-8224
Mailing Address - Fax:540-662-8230
Practice Address - Street 1:817 CEDAR CREEK GRADE
Practice Address - Street 2:SUITE 100
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2706
Practice Address - Country:US
Practice Address - Phone:540-662-8224
Practice Address - Fax:540-662-8230
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50173207RC0000X
VA0101050179207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1841279916OtherANTHEM BCBS
VA1841279916Medicaid
WV0085995000Medicaid
VAP00777839OtherMEDICARE RR
VA1841279916Medicaid
VAP00777839OtherMEDICARE RR
VA1841279916OtherANTHEM BCBS