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NPI Code Detail

MEDICARE: DR. AMY REBMAN DIETRICH MD

MEDICARE: DR. AMY REBMAN DIETRICH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician24435SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
124435OTHERSCBOARD OF MEDICAL EXAMINER
220-24435OTHERSCDHEC

General Provider Information

NPI Number : 1447250378
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMY REBMAN DIETRICH MD
Provider Business Mailing Address
First Line : 2713 DANTZLER DR
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-9005
Country : US
Telephone Number : 843-764-1722
Fax Number : 843-764-1788
Provider Business Practice Location Address
First Line : 2713 DANTZLER DR
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406-9005
Country : US
Telephone Number : 843-764-1722
Fax Number : 843-764-1788
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 07/26/2013

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