Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC003722L | PA |
Y | 222Z00000X | Podiatrist | SC003722L | PA |
NPI | 1003842840 |
---|---|
Provider Name | Scott T Dittus |
First Address | North Wales, PA 19454-2167 |
Second Address | Wernersville, PA 19565-0300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 21/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U47684 | (02) | PA |