Provider Demographics
NPI:1750777231
Name:DITCHEY, LISA M (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:DITCHEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:265 PORTAGE TRAIL EXT W STE 200
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3613
Mailing Address - Country:US
Mailing Address - Phone:330-928-3111
Mailing Address - Fax:
Practice Address - Street 1:525 EAST MARKET STREET
Practice Address - Street 2:SUMMA HEALTH SYSTEM/FAMILY MEDICINE RESIDENCY
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44309
Practice Address - Country:US
Practice Address - Phone:330-375-3761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.013318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0152458Medicaid