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Individual

MARTIN DITTLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1613 OAKWOOD ST, BEDFORD, VA 24523-1213
(540) 586-2441
Mailing address
124 WEDGEWOOD DR, ROCKY MOUNT, VA 24151-4888

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001082217
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024082217
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8955107
VA
05
8955115
VA
05
8955123
VA
05
8955140
VA
05
8955158
VA
Enumeration date
08/31/2006
Last updated
05/06/2008
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