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General NPI Number Information
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NPI Number | 1770779084
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Entity Type | Organization
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Legal Business Name | S DOUGLAS DEITCH MD PSC
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 2301 LEXINGTON AVE SUITE 310
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City | ASHLAND
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State | KY
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Zip | 41101-2873
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Country | US
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Telephone | 606-325-3299
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Fax | 606-325-1386
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Provider Business Mailing Address
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Address Line | 2301 LEXINGTON AVE SUITE 310
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City | ASHLAND
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State | KY
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Zip | 41101-2873
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Country | US
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Telephone | 606-325-3299
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Fax | 606-325-1386
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN DOUGLAS DEITCH
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Credential | MD
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Telephone | 606-325-3299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 26535
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License Number State | KY
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