Provider Demographics
NPI:1720106685
Name:DITTOE, NATHANIEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:JOSEPH
Last Name:DITTOE
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 1:1380 E STROOP RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4926
Mailing Address - Country:US
Mailing Address - Phone:937-293-3486
Mailing Address - Fax:937-293-3605
Practice Address - Street 1:1500 JAMES SIMPSON JR WAY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-0801
Practice Address - Country:US
Practice Address - Phone:859-655-9500
Practice Address - Fax:859-655-3077
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089064207RC0000X
IN207RC0000X207RC0000X
KY44104207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2758645Medicaid
KY7100176710Medicaid
KY7100176710Medicaid
KYK010333Medicare PIN