Provider Demographics
NPI:1982706032
Name:PITEGOFF, JOHN GERALD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GERALD
Last Name:PITEGOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:20 HIGH POINT LN
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1135
Mailing Address - Country:US
Mailing Address - Phone:860-232-3314
Mailing Address - Fax:860-232-1867
Practice Address - Street 1:1225 SILVER ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3920
Practice Address - Country:US
Practice Address - Phone:860-638-2620
Practice Address - Fax:860-638-2630
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0268282080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001268285Medicaid
CT010026828CTOtherANTHEM BLUE CARE