Provider Demographics
NPI:1528154903
Name:DEITCH, CHRISTOPHER W (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:DEITCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:501 FELLOWSHIP RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3419
Practice Address - Country:US
Practice Address - Phone:856-642-2133
Practice Address - Fax:856-642-2134
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMD4521207RG0100X
PAMD067373L207RG0100X
NJMA68756207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0273472000OtherAMERIHEALTH HMO
DE1000034278OtherDELAWARE MEDICAID
NJ1952022OtherUNITED HEALTHCARE
DEG01766C02OtherDELAWARE MEDICARE
NJ010003876 00OtherAMERICHOICE
NJ1104170OtherHORIZON NJ HEALTH
NJ26245OtherCHRISITIANA CARE HEALTH PLAN
NJ540720OtherAMERIHEALTH PPO PABS
NJ8039801Medicaid
NJP1950223OtherOXFORD UNITED
NJ2184185OtherAETNA US HEALTH CARE
NJ3644352OtherAETNA US HEALTHCARE
NJ100015835OtherRAILROAD MEDICARE
DE1682129OtherAMERIHEALTH PPO OF DELAWARE
NJ1K6918OtherHEALTHNET, INC
NJ223266219OtherCONVENTRY HEALTH PLAN
DE2355748000OtherAMERIHEALTH HMO OF DELAWARE
NJ24668OtherUNIVERSITY HEALTH PLAN
NJ9291506OtherCIGNA
DE1682129OtherAMERIHEALTH PPO OF DELAWARE
NJ100015835OtherRAILROAD MEDICARE
NJ8039801Medicaid