Healthcare Provider Details

I. General information

NPI: 1265739668
Provider Name (Legal Business Name): RONALD LEE DIENER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GLENCLIFFE CIR
PIKESVILLE MD
21208-3401
US

IV. Provider business mailing address

10 GLENCLIFFE CIR
PIKESVILLE MD
21208-3401
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-7090
  • Fax: 410-296-7090
Mailing address:
  • Phone: 410-296-7090
  • Fax: 410-296-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0001906
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: