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Individual

KENNETH DEITCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
101 E OLNEY AVE, SUITE 400, PHILA, PA 19120-2421
(215) 456-7000
(215) 254-2599
Mailing address
5501 OLD YORK RD, PHILA, PA 19141-3018
(215) 456-6679
(215) 456-8502

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS012659
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
232664784
TAX ID #
PA
Enumeration date
06/05/2006
Last updated
11/11/2011
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