MEDICARE: MONICA MARIE DITTMER PAC

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	363AS0400X	Surgical Physician Assistant	000102624	NC
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1730168055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA MARIE DITTMER PAC

Provider Business Mailing Address
First Line	:	1701 WESTCHESTER DR STE 850
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27262-7254
Country	:	US
Telephone Number	:	336-716-1331
Fax Number	:	336-716-3202

Provider Business Practice Location Address
First Line	:	4515 PREMIER DR STE 404
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8356
Country	:	US
Telephone Number	:	336-802-2085
Fax Number	:	336-802-2086

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	07/21/2022

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Directions to “ MONICA MARIE DITTMER PAC” Practice Location

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