Healthcare Provider Details

I. General information

NPI: 1518942168
Provider Name (Legal Business Name): WILLIAM ARNOLD DIEDRICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 01/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LANTERN LN
PLAIN CITY OH
43064-2128
US

IV. Provider business mailing address

320 LANTERN LN
PLAIN CITY OH
43064-2128
US

V. Phone/Fax

Practice location:
  • Phone: 614-873-5041
  • Fax: 614-873-5041
Mailing address:
  • Phone: 614-873-5041
  • Fax: 614-873-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35.088724
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD440611
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number01068477A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberC1-0002979
License Number StateDE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: