Healthcare Provider Details

I. General information

NPI: 1396810826
Provider Name (Legal Business Name): MALCOLM H. DIETRICH D.O. LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E MARKET ST
YORK PA
17403-1251
US

IV. Provider business mailing address

1300 E MARKET ST
YORK PA
17403-1251
US

V. Phone/Fax

Practice location:
  • Phone: 717-843-4844
  • Fax: 717-854-5288
Mailing address:
  • Phone: 717-843-4844
  • Fax: 717-854-5288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS002279L
License Number StatePA

VIII. Authorized Official

Name: DR. MALCOLM HOWARD DIETRICH
Title or Position: FAMILY PRACTITIONER
Credential: D.O.
Phone: 717-843-4844