Provider Demographics
NPI:1598766750
Name:DITTO, STEVEN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RICHARD
Last Name:DITTO
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:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-0567
Mailing Address - Country:US
Mailing Address - Phone:216-464-5160
Mailing Address - Fax:216-464-5982
Practice Address - Street 1:850 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1493
Practice Address - Country:US
Practice Address - Phone:440-808-4000
Practice Address - Fax:440-808-4010
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052168207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00908726OtherMEDICARE RAILROAD
PA1025598300001Medicaid
OH0600479Medicaid
OHP00908726OtherMEDICARE RAILROAD
OH0600479Medicaid
OHDI0635033Medicare PIN