Provider Demographics
NPI:1003842840
Name:DITTUS, SCOTT T (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:T
Last Name:DITTUS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 LOWER STATE RD
Mailing Address - Street 2:UNIT 17CZ
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2167
Mailing Address - Country:US
Mailing Address - Phone:215-591-9061
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 422, SPORTSMAN ROAD
Practice Address - Street 2:BUILDING 37
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-0300
Practice Address - Country:US
Practice Address - Phone:610-678-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003722L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU47684Medicare UPIN
753915Medicare PIN