Ditelberg, Jeremy Stuart
Ditelberg, Jeremy Stuart is an sole proprietor health care provider with primary practice located at 320 Needham Street Suite 200, Newton MA 02464. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anatomic Pathology, Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology. Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology is his primary health care specialty. Ditelberg, Jeremy Stuart can be contacted via phone (617) 969-4100.Contact Information
Primary practice address
320 Needham Street Suite 200
Newton MA 02464
Phone: (617) 969-4100
Fax: (617) 969-3393
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anatomic Pathology | 207ZP0101X | 159430 | Massachusetts |
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | 159430 | Massachusetts |
Profile Details
| NPI number | 1629037148 |
|---|---|
| LBN Legal business name | Ditelberg, Jeremy Stuart |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 22nd, 2006 |
| Last updated | Nov 21st, 2013 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629037148 | NPPES |
| Massachusetts | MEDICAID | 0191515 |
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