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Organization
S DOUGLAS DEITCH MD PSC
Active
Organization
S DOUGLAS DEITCH MD PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN DOUGLAS DEITCH MD (OWNER)
(606) 325-3299
Entity
Organization
Contact information
Practice address
2301 LEXINGTON AVE, SUITE 310, ASHLAND, KY 41101-2873
(606) 325-3299
(606) 325-1386
Mailing address
2301 LEXINGTON AVE, SUITE 310, ASHLAND, KY 41101-2873
(606) 325-3299
(606) 325-1386
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
26535
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000049311
BLUE CROSS
KY
05
—
0042484000
—
WV
05
—
0742594
—
OH
01
—
1030745
WEST VIRGINIA WORKERS COM
KY
01
—
1389552
UMWA
KY
01
—
1498201
MEDICARE ID
KY
01
—
4347345
AETNA
KY
01
—
4982
MEDICARE ID GROUP
KY
05
—
64265358
—
KY
Enumeration date
09/20/2007
Last updated
04/20/2008
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