Healthcare Provider Details

I. General information

NPI: 1629184239
Provider Name (Legal Business Name): MEREDITH LEIGH DIEHL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH DIEHL BRENA MD

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 GASKINS RD
HENRICO VA
23233-1441
US

IV. Provider business mailing address

3855 GASKINS RD
RICHMOND VA
23233-1441
US

V. Phone/Fax

Practice location:
  • Phone: 804-217-6363
  • Fax: 804-217-6400
Mailing address:
  • Phone: 804-290-4278
  • Fax: 804-217-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number0101241405
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberT2004009604
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: