1225194202 NPI number — DR. ELISABETH ROSANNE DIEHL D.O.

Table of content: DR. ELISABETH ROSANNE DIEHL D.O. (NPI 1225194202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225194202 NPI number — DR. ELISABETH ROSANNE DIEHL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIEHL
Provider First Name:
ELISABETH
Provider Middle Name:
ROSANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIEHL
Provider Other First Name:
E.
Provider Other Middle Name:
ROSANNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1225194202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 460
Provider Second Line Business Mailing Address:
5576 GREENVILLE HWY 460
Provider Business Mailing Address City Name:
ZIRCONIA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28790-0460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-915-3212
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 N HIGHWAY 25
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRAVELERS REST
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29690-8208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-834-6652
Provider Business Practice Location Address Fax Number:
864-834-6654
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  97-00530 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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