Provider Demographics
NPI:1942907035
Name:DITCH, CAITLIN
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:DITCH
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 1:1088 SUMMITVILLE DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-4146
Mailing Address - Country:US
Mailing Address - Phone:585-301-6007
Mailing Address - Fax:
Practice Address - Street 1:1088 SUMMITVILLE DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-4146
Practice Address - Country:US
Practice Address - Phone:585-301-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14045792012080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
203371400OtherBLUE CROSS BLUE SHIELD
203371400OtherEXCELLUS
YNC2033714OtherEXCELLUS
YNC203371400OtherEXCELLUS
003858OtherEXCELLUS
2033714OtherEXCELLUS