Provider Demographics
NPI:1912003781
Name:DEITCH, STEVEN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:DEITCH
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 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-4000
Mailing Address - Fax:
Practice Address - Street 1:617 23RD ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2880
Practice Address - Country:US
Practice Address - Phone:606-326-0300
Practice Address - Fax:606-326-0235
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26535174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64265358Medicaid
KY000000049311OtherBLUE CROSS
WV1030745OtherWEST VIRGINIA WORKERS COM
KY26-4183569OtherAETNA
OH0742594Medicaid
KY4347345OtherAETNA
KY000000733227OtherBCBS
WV0042484000Medicaid
KY4347345OtherAETNA
KY000000733227OtherBCBS
WV0042484000Medicaid