Provider Demographics
NPI:1629044235
Name:DITCHEY, ROY V (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:V
Last Name:DITCHEY
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 1:2638 EDITH AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3043
Mailing Address - Country:US
Mailing Address - Phone:530-244-7192
Mailing Address - Fax:949-222-3448
Practice Address - Street 1:2638 EDITH AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3043
Practice Address - Country:US
Practice Address - Phone:530-244-7192
Practice Address - Fax:530-244-4185
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37783207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G377830Medicaid
CAB85551Medicare UPIN
CA00G377831Medicare Oscar/Certification