Healthcare Provider Details

I. General information

NPI: 1972575850
Provider Name (Legal Business Name): CYNTHIA LYN DIEHL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10208 CERNY ST SUITE 204
RALEIGH NC
27617-7884
US

IV. Provider business mailing address

10208 CERNY ST SUITE 204
RALEIGH NC
27617-7884
US

V. Phone/Fax

Practice location:
  • Phone: 919-381-5540
  • Fax: 919-381-5547
Mailing address:
  • Phone: 919-381-5540
  • Fax: 919-381-5547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number9701469
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number9701469
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: