Healthcare Provider Details

I. General information

NPI: 1003842840
Provider Name (Legal Business Name): SCOTT T DITTUS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 422, SPORTSMAN ROAD BUILDING 37
WERNERSVILLE PA
19565-0300
US

IV. Provider business mailing address

700 LOWER STATE RD UNIT 17CZ
NORTH WALES PA
19454-2167
US

V. Phone/Fax

Practice location:
  • Phone: 610-678-3411
  • Fax:
Mailing address:
  • Phone: 215-591-9061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC003722L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: