Basic Information
| Provider Information | |||||||||
| NPI: | 1528154903 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEITCH | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 FEDERAL ST # 200 | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081031088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563564924 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 FELLOWSHIP RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080543419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566422133 | ||||||||
| FaxNumber: | 8566422134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 04/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD4521 | DE | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | MD067373L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | MA68756 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 0273472000 | 01 | NM | AMERIHEALTH HMO | OTHER | 1000034278 | 01 | DE | DELAWARE MEDICAID | OTHER | 1952022 | 01 | NJ | UNITED HEALTHCARE | OTHER | G01766C02 | 01 | DE | DELAWARE MEDICARE | OTHER | 010003876 00 | 01 | NJ | AMERICHOICE | OTHER | 1104170 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 26245 | 01 | NJ | CHRISITIANA CARE HEALTH PLAN | OTHER | 540720 | 01 | NJ | AMERIHEALTH PPO PABS | OTHER | 8039801 | 05 | NJ | MEDICAID | P1950223 | 01 | NJ | OXFORD UNITED | OTHER | 2184185 | 01 | NJ | AETNA US HEALTH CARE | OTHER | 3644352 | 01 | NJ | AETNA US HEALTHCARE | OTHER | 100015835 | 01 | NJ | RAILROAD MEDICARE | OTHER | 1682129 | 01 | DE | AMERIHEALTH PPO OF DELAWARE | OTHER | 1K6918 | 01 | NJ | HEALTHNET, INC | OTHER | 223266219 | 01 | NJ | CONVENTRY HEALTH PLAN | OTHER | 2355748000 | 01 | DE | AMERIHEALTH HMO OF DELAWARE | OTHER | 24668 | 01 | NJ | UNIVERSITY HEALTH PLAN | OTHER | 9291506 | 01 | NJ | CIGNA | OTHER |