Healthcare Provider Details

I. General information

NPI: 1629056114
Provider Name (Legal Business Name): ROBIN Z DIETLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN ZIMMERMAN

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9104 BABCOCK BLVD SUITE 1106
PITTSBURGH PA
15237
US

IV. Provider business mailing address

200 LATHROP STREET SUITE 9055 FORBES TOWER
PITTSBURGH PA
15213-2536
US

V. Phone/Fax

Practice location:
  • Phone: 412-366-6841
  • Fax: 412-366-8650
Mailing address:
  • Phone: 412-647-3087
  • Fax: 412-647-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD027522E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: