Provider Demographics
NPI:1114917267
Name:DITTMER, JAMES ALBERT (MSCCC/A)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALBERT
Last Name:DITTMER
Suffix:
Gender:M
Credentials:MSCCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 N CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2103
Mailing Address - Country:US
Mailing Address - Phone:301-722-8060
Mailing Address - Fax:301-724-4448
Practice Address - Street 1:508 N CENTRE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2103
Practice Address - Country:US
Practice Address - Phone:301-722-8060
Practice Address - Fax:301-724-4448
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00793231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist