Provider Demographics
NPI:1659562890
Name:DITTMER, CHRISTINE DENISE (MD, MPH, MS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:DENISE
Last Name:DITTMER
Suffix:
Gender:F
Credentials:MD, MPH, MS
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:DITTMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1012 VANCE ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2260
Mailing Address - Country:US
Mailing Address - Phone:919-794-6398
Mailing Address - Fax:919-834-0539
Practice Address - Street 1:1407 HILLSBOROUGH ST
Practice Address - Street 2:204
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1828
Practice Address - Country:US
Practice Address - Phone:919-794-6398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC015452084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry