Jeremy Stuart Ditelberg, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

159430 Issued in MA

Practice address

320 Needham Street
Suite 200
Newton, MA 02464

Phone

(617) 969-4100

Fax

(617) 969-3393

NPI assigned

Mar 22, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cohen Dermatopathology, PC

  • Clinical Medical Laboratory
  • Columbia, MD
  • NPI 1922443324
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384992000000",
    "number": "1629037148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840294",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752840294",
            "telephone_number": "888-344-1160",
            "fax_number": "972-331-3148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 NEEDHAM STREET",
            "address_2": "SUITE 200",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "02464",
            "telephone_number": "617-969-4100",
            "fax_number": "617-969-3393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DITELBERG",
        "first_name": "JEREMY",
        "middle_name": "STUART",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-22",
        "last_updated": "2013-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0101X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology",
            "state": "MA",
            "license": "159430",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MA",
            "license": "159430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0191515",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krystal Virginia Dimario
• William Kenney Dimmick, LICSW
• Casey J. Dinicola
• Susan Diracco, PT
• Jennifer Lynn Dirga
• Rachel Diverdi
• DK Foster Care
• Lance M Dodes, M.D.
• Shelby Elise Dodier
• Keisha Gwendoline Dodman, M.D.

• Anatomic Pathology & Clinical Pathology Physician in Newton, MA
• Providers in Newton, MA by specialty
• Anatomic Pathology & Clinical Pathology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.