Organization
JOHN DEITRICK MD CONSULTING, LLC
Active
Organization
JOHN DEITRICK MD CONSULTING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN C DEITRICK MD (OWNER)
(804) 241-5911
Entity
Organization
Contact information
Practice address
173 WADSWORTH DR, NORTH CHESTERFIELD, VA 23236-4500
(804) 674-5957
Mailing address
PO BOX 8987, RICHMOND, VA 23225-0687
(804) 241-5911
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
0101037598
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1457338741
TYPE 1 NPI
VA
Enumeration date
06/04/2018
Last updated
02/18/2021
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