Provider Demographics
NPI:1245434893
Name:THOMAS H. DITTMAN, M.D.
Entity type:Organization
Organization Name:THOMAS H. DITTMAN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:DITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-453-0550
Mailing Address - Street 1:20 N LAUREL ST
Mailing Address - Street 2:SUITE 2 E
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5948
Mailing Address - Country:US
Mailing Address - Phone:570-453-0550
Mailing Address - Fax:570-453-0138
Practice Address - Street 1:20 N LAUREL ST
Practice Address - Street 2:SUITE 2 E
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5948
Practice Address - Country:US
Practice Address - Phone:570-453-0550
Practice Address - Fax:570-453-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015439E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009513120002Medicaid
PA0009513120002Medicaid
PAB36963Medicare UPIN