Individual
MARY E DITKOFF
Active
Individual
MARY E DITKOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10003248
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039625
LABOR AND INDUSTRIES #
WA
05
—
8359978
—
WA
01
—
970015494
RAILROAD MEDICARE
WA
01
—
DI9722
BLUE SHIELD#
WA
01
—
US2023373
AETNA SPECIALIST PIN
WA
Enumeration date
02/02/2007
Last updated
03/04/2015
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