Individual
DANIELLE DEITRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1200 S CEDAR CREST BLVD, ALLENTOWN, PA 18103-6202
(484) 862-3232
Mailing address
801 OSTRUM ST, BETHLEHEM, PA 18015-1000
(610) 954-3383
(610) 954-6500
Taxonomy
Speciality
Code
Description
License number
State
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
01/23/2026
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