Provider Demographics
NPI:1962465575
Name:LITSEY, DAMON SCOTT (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:SCOTT
Last Name:LITSEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 FAIRY FALLS DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2803
Mailing Address - Country:US
Mailing Address - Phone:740-622-0338
Mailing Address - Fax:888-730-2212
Practice Address - Street 1:1100 FAIRY FALLS DR
Practice Address - Street 2:SUITE 5
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2803
Practice Address - Country:US
Practice Address - Phone:740-622-0338
Practice Address - Fax:888-730-2212
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002656L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2832582Medicaid
OH6134090001Medicare NSC
OH2832582Medicaid
OH9375471Medicare PIN