1629184239 NPI number — MEREDITH LEIGH DIEHL MD

Table of content: MR. MICHAEL ORENSTEIN LCSW (NPI 1891715082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629184239 NPI number — MEREDITH LEIGH DIEHL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIEHL
Provider First Name:
MEREDITH
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRENA
Provider Other First Name:
MEREDITH
Provider Other Middle Name:
DIEHL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629184239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3855 GASKINS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23233-1441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-290-4278
Provider Business Mailing Address Fax Number:
804-217-6400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3855 GASKINS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENRICO
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23233-1441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-217-6363
Provider Business Practice Location Address Fax Number:
804-217-6400
Provider Enumeration Date:
08/23/2006

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: 207WX0109X , with the licence number:  0101241405 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: T2004009604 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1629184239 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 302628 . This is a "HEALTHKEEPERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 302628 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7208981 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2168499 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1629184239 . This is a "VA PREMIER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10022943 . This is a "OPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 014324V49 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2168499 . This is a "MD IPA" identifier . This identifiers is of the category "OTHER".




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