Healthcare Provider Details

I. General information

NPI: 1588687164
Provider Name (Legal Business Name): WILLIAM DIEHL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 ARSENAL ST
AUGUSTA ME
04330-5704
US

IV. Provider business mailing address

79 ARSENAL ST
AUGUSTA ME
04330-5704
US

V. Phone/Fax

Practice location:
  • Phone: 207-622-1445
  • Fax:
Mailing address:
  • Phone: 207-622-1445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number006361
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: