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Individual
DANIELLE DEITRICK
Active
Individual
DANIELLE DEITRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
C2-0024339
DE
207P00000X
Emergency Medicine Physician
Primary
OS013313
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001877624
BLUE SHIELD
PA
05
—
101709600
—
PA
05
—
1017096000003
—
PA
01
—
1877624
BLUE SHIELD
PA
01
—
P00425300
RR MEDICARE
PA
Enumeration date
06/28/2006
Last updated
07/07/2026
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