MEDICARE: CHRISTOPHER W. DEITCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	MD4521	DE
2	207RG0100X	Gastroenterology Physician	MD067373L	PA
3	207RG0100X	Gastroenterology Physician	MA68756	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	G01766C02	OTHER	DE	DELAWARE MEDICARE
13	100015835	OTHER	NJ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0273472000	OTHER	NM	AMERIHEALTH HMO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1952022	OTHER	NJ	UNITED HEALTHCARE
5	010003876 00	OTHER	NJ	AMERICHOICE
6	1104170	OTHER	NJ	HORIZON NJ HEALTH
7	26245	OTHER	NJ	CHRISITIANA CARE HEALTH PLAN
8	540720	OTHER	NJ	AMERIHEALTH PPO PABS
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	P1950223	OTHER	NJ	OXFORD UNITED
11	2184185	OTHER	NJ	AETNA US HEALTH CARE
12	3644352	OTHER	NJ	AETNA US HEALTHCARE
14	1682129	OTHER	DE	AMERIHEALTH PPO OF DELAWARE
15	1K6918	OTHER	NJ	HEALTHNET, INC
16	223266219	OTHER	NJ	CONVENTRY HEALTH PLAN
17	2355748000	OTHER	DE	AMERIHEALTH HMO OF DELAWARE
18	24668	OTHER	NJ	UNIVERSITY HEALTH PLAN
19	9291506	OTHER	NJ	CIGNA

General Provider Information

NPI Number	:	1528154903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER W. DEITCH MD

Provider Business Mailing Address
First Line	:	1 FEDERAL ST # 200
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1088
Country	:	US
Telephone Number	:	856-356-4924
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 FELLOWSHIP RD
Second Line	:	SUITE 101
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-3419
Country	:	US
Telephone Number	:	856-642-2133
Fax Number	:	856-642-2134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	04/02/2019

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