1588908552 NPI number — FRANK DITTRICH DO LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588908552 NPI number — FRANK DITTRICH DO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANK DITTRICH DO LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588908552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2104 FRONT STREET
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CUYAHOGA FALLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44221-3259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-923-3502
Provider Business Mailing Address Fax Number:
330-923-3507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2104 FRONT STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CUYAHOGA FALLS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44221-3259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-923-3502
Provider Business Practice Location Address Fax Number:
330-923-3507
Provider Enumeration Date:
11/15/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DITTRICH
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYISICIAN
Authorized Official Telephone Number:
330-923-3502

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  34001810 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)