Healthcare Provider Details

I. General information

NPI: 1720452725
Provider Name (Legal Business Name): MS. RACHEL DIETRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2015
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 INDUSTRIAL PARK DR STE 103C
WALDORF MD
20602-2751
US

IV. Provider business mailing address

1611 21ST ST NW APT 2
WASHINGTON DC
20009-1046
US

V. Phone/Fax

Practice location:
  • Phone: 301-818-0030
  • Fax:
Mailing address:
  • Phone: 248-835-5944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: