Healthcare Provider Details

I. General information

NPI: 1952483349
Provider Name (Legal Business Name): DENISE SCARINGE-DIETRICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE SCARINGE M.D.

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 MIDLANTIC DR STE 102
MOUNT LAUREL NJ
08054-1573
US

IV. Provider business mailing address

15000 MIDLANTIC DR STE 102
MOUNT LAUREL NJ
08054-1573
US

V. Phone/Fax

Practice location:
  • Phone: 855-727-2465
  • Fax: 856-393-8372
Mailing address:
  • Phone: 855-727-2465
  • Fax: 856-393-8372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD064392L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberC1-0011321
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MA07412900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberC1-0011321
License Number StateDE
# 5
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MA07412900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: