MEDICARE: LISA M DITCHEY DO

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	34.013318	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750777231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA M DITCHEY DO

Provider Business Mailing Address
First Line	:	265 PORTAGE TRAIL EXT W STE 200
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44223-3613
Country	:	US
Telephone Number	:	330-928-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 EAST MARKET STREET
Second Line	:	SUMMA HEALTH SYSTEM/FAMILY MEDICINE RESIDENCY
City	:	AKRON
State	:	OH
Zip	:	44309
Country	:	US
Telephone Number	:	330-375-3761
Fax Number	:

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

Provider Enumeration Date	:	04/10/2015
Last Update Date	:	08/13/2018

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