Healthcare Provider Details

I. General information

NPI: 1871823591
Provider Name (Legal Business Name): DIEHL PLASTIC SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9636 CLUB VALLEY WAY
RALEIGH NC
27617-8604
US

IV. Provider business mailing address

9636 CLUBVALLEY WAY
RALEIGH NC
27617-8604
US

V. Phone/Fax

Practice location:
  • Phone: 919-237-1097
  • Fax: 919-873-9244
Mailing address:
  • Phone: 919-237-1097
  • Fax: 919-873-9244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1972575850
License Number StateNC

VIII. Authorized Official

Name: CYNTHIA L DIEHL
Title or Position: PRESIDENT
Credential: MD
Phone: 919-237-1097