Provider Demographics
NPI:1073660783
Name:DITTMER, JOSHUA EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:EUGENE
Last Name:DITTMER
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 1:805 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1509
Mailing Address - Country:US
Mailing Address - Phone:919-322-8832
Mailing Address - Fax:919-747-2928
Practice Address - Street 1:8300 HEALTH PARK STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4731
Practice Address - Country:US
Practice Address - Phone:919-322-8832
Practice Address - Fax:919-747-2928
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008007452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909700Medicaid
NC5909700Medicaid