Healthcare Provider Details

I. General information

NPI: 1073547030
Provider Name (Legal Business Name): DINUSHA W DIETRICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SMITH AVE STE 103
GREENVILLE RI
02828-1700
US

IV. Provider business mailing address

7 SMITH AVE STE 103
GREENVILLE RI
02828-1700
US

V. Phone/Fax

Practice location:
  • Phone: 401-231-3138
  • Fax: 401-231-4757
Mailing address:
  • Phone: 401-231-3138
  • Fax: 401-231-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD10951
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: