Provider Demographics
NPI:1316964976
Name:DITKOFF, BETH ANN (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:DITKOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 STRAWBERRY HILL CT
Mailing Address - Street 2:SUITE 8
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2594
Mailing Address - Country:US
Mailing Address - Phone:203-276-4255
Mailing Address - Fax:203-276-4259
Practice Address - Street 1:32 STRAWBERRY HILL CT
Practice Address - Street 2:SUITE 8
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-276-4255
Practice Address - Fax:203-276-4259
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042643208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTTINOtherNEHCA HMC/PPO
CTTINOtherCHN SOLUTIONS
CTTINOtherNORTHEAST HEALTH DIRECT
CTTINOtherUNITED
CTTINOtherPRIVATE HEALTHCARE SYSTEM
CTTINOtherFIRST HEALTH
CT0803905OtherCIGNA
CT2V5578OtherHEALTH NET
CT426430OtherCONNECTICARE
CT3630H1OtherEMPIRE BC/BS
CTTINOtherPIONEER
CTP421476OtherOXFORD HEALTH PLANS
CTP00206735OtherRAILROAD MEDICARE
CT3632337OtherAETNA
CTTINOtherFOCUS
CTTINOtherCREAT WEST
CTTINOtherANTHEM BC/BS
CTTINOtherPOMCO
CTTINOtherFIRST HEALTH