Healthcare Provider Details

I. General information

NPI: 1700511912
Provider Name (Legal Business Name): LAUREN ELIZABETH DIEM PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S 43RD ST
PHILADELPHIA PA
19104-4418
US

IV. Provider business mailing address

1816 LINCOLN DR E
AMBLER PA
19002-3844
US

V. Phone/Fax

Practice location:
  • Phone: 215-596-8800
  • Fax:
Mailing address:
  • Phone: 610-314-5342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: