Provider Demographics
NPI:1649333618
Name:DEITZ, JOHN CALVIN (BS RDGS RDCS RVT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CALVIN
Last Name:DEITZ
Suffix:
Gender:M
Credentials:BS RDGS RDCS RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1258 OLD JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2607
Mailing Address - Country:US
Mailing Address - Phone:215-322-2943
Mailing Address - Fax:215-322-3011
Practice Address - Street 1:1258 OLD JORDAN RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-2607
Practice Address - Country:US
Practice Address - Phone:215-322-2943
Practice Address - Fax:215-322-3011
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Not Answered2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
Not Answered246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography