Individual
DR. JACK F DITTY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 STADIUM DRIVE, MORGANTOWN, WV 26505
(304) 598-4000
(304) 293-6963
Mailing address
P. O. BOX 897, MORGANTOWN, WV 26507-0897
(304) 293-7401
(304) 293-6963
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
21600
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810002302
—
WV
Enumeration date
10/16/2006
Last updated
07/08/2007
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