Provider Demographics
NPI:1477648483
Name:PAUL R. DITTES, M.D., PC
Entity Type:Organization
Organization Name:PAUL R. DITTES, M.D., PC
Other - Org Name:UPDATE VEIN LASER TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DITTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-459-8200
Mailing Address - Street 1:4 EXECUTIVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3718
Mailing Address - Country:US
Mailing Address - Phone:518-459-8200
Mailing Address - Fax:
Practice Address - Street 1:4 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3718
Practice Address - Country:US
Practice Address - Phone:518-459-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty