Provider Demographics
NPI:1851669394
Name:DITTRICH, MELISSA SMITH (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SMITH
Last Name:DITTRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 MAYO RD STE A
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2951
Mailing Address - Country:US
Mailing Address - Phone:410-956-6302
Mailing Address - Fax:410-956-6637
Practice Address - Street 1:224 MAYO RD STE A
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2951
Practice Address - Country:US
Practice Address - Phone:410-956-6302
Practice Address - Fax:410-956-6637
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058782208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics