Individual
JOHN C DEITRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1051 JOHNSTON WILLIS DR, STE 200, RICHMOND, VA 23235
(804) 320-2705
(804) 330-2433
Mailing address
1051 JOHNSTON WILLIS DR, STE 200, RICHMOND, VA 23235
(804) 320-2705
(804) 330-2433
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
0101037598
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457338741
—
VA
05
—
7354380
—
VA
Enumeration date
12/28/2005
Last updated
01/13/2010
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