Healthcare Provider Details

I. General information

NPI: 1629754551
Provider Name (Legal Business Name): NATALIE DZIADON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 07/02/2023
Certification Date: 07/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13662 MOLLY PITCHER HIGHWAY
GREENCASTLE PA
17225
US

IV. Provider business mailing address

17423 LEXINGTON AVE
HAGERSTOWN MD
21740
US

V. Phone/Fax

Practice location:
  • Phone: 301-991-2137
  • Fax:
Mailing address:
  • Phone: 301-302-1267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberP4TMQKLIO3
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: