Healthcare Provider Details

I. General information

NPI: 1447227913
Provider Name (Legal Business Name): TIMOTHY NICHOLAS DITTLINGER
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2538
US

IV. Provider business mailing address

323 ROCK CREEK DR S
JACKSONVILLE NC
28540-9330
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-1323
  • Fax: 910-450-0914
Mailing address:
  • Phone: 910-324-7173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: