Healthcare Provider Details

I. General information

NPI: 1659562890
Provider Name (Legal Business Name): CHRISTINE DENISE DITTMER M.D., MPH, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE DITTMER

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 HILLSBOROUGH ST 204
RALEIGH NC
27605-1828
US

IV. Provider business mailing address

1012 VANCE ST
RALEIGH NC
27608-2260
US

V. Phone/Fax

Practice location:
  • Phone: 919-794-6398
  • Fax:
Mailing address:
  • Phone: 919-794-6398
  • Fax: 919-834-0539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number01545
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: