Provider Demographics
NPI:1619400918
Name:DITTMAN, SYDNEY CELESTE
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:CELESTE
Last Name:DITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13001 E 17TH PL
Mailing Address - Street 2:UNIVERSITY OF COLORADO SCHOOL OF MEDICINE GME
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2570
Mailing Address - Country:US
Mailing Address - Phone:303-584-7900
Mailing Address - Fax:
Practice Address - Street 1:4545 E 9TH AVE STE 10
Practice Address - Street 2:ROSE FAMILY MEDICINE CENTER
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3907
Practice Address - Country:US
Practice Address - Phone:303-584-7913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0061080207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine