Provider Demographics
NPI:1972981215
Name:DITAH, CALLISTUS N (MD)
Entity type:Individual
Prefix:DR
First Name:CALLISTUS
Middle Name:N
Last Name:DITAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:739 IRVING AVE
Mailing Address - Street 2:SUITE 640
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-5095
Mailing Address - Country:US
Mailing Address - Phone:315-464-6255
Mailing Address - Fax:615-464-6251
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 640
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-5095
Practice Address - Country:US
Practice Address - Phone:315-464-6255
Practice Address - Fax:615-464-6251
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2024-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY330140208G00000X
WAMD61423828208G00000X
WI67557-20208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)