Healthcare Provider Details

I. General information

NPI: 1407275621
Provider Name (Legal Business Name): EMILY GLASS DIETLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY KATHARINE GLASS

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

PO BOX 744785
ATLANTA GA
30374-4785
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5000
  • Fax:
Mailing address:
  • Phone: 202-476-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080T0004X
TaxonomyPediatric Transplant Hepatology Physician
License NumberMD600005644
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD600005644
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: