Healthcare Provider Details

I. General information

NPI: 1720106685
Provider Name (Legal Business Name): NATHANIEL JOSEPH DITTOE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 JAMES SIMPSON JR WAY
COVINGTON KY
41011-0801
US

IV. Provider business mailing address

P.O. BOX 636324
CINCINNATI OH
45263-6324
US

V. Phone/Fax

Practice location:
  • Phone: 859-287-3045
  • Fax: 859-655-3077
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-344-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number44104
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number207RC0000X
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35089064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: