Healthcare Provider Details

I. General information

NPI: 1750382123
Provider Name (Legal Business Name): EARL H. DIEHL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N ROBINSON ST SUITE 300
RICHMOND VA
23220-4459
US

IV. Provider business mailing address

107 WADSWORTH DR
RICHMOND VA
23236-4521
US

V. Phone/Fax

Practice location:
  • Phone: 804-353-4916
  • Fax: 804-254-5216
Mailing address:
  • Phone: 804-330-4901
  • Fax: 804-330-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101029248
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: