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General NPI Number Information
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NPI Number | 1205990256
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Entity Type | Individual
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Provider Name | DIERICH MARK KAISER MD
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Gender | Male
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 2501 N 3RD ST
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City | HARRISBURG
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State | PA
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Zip | 17110-1904
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Country | US
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Telephone | 717-782-6430
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Fax | 717-782-6431
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Provider Business Mailing Address
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Address Line | PO BOX 858
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City | HERSHEY
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State | PA
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Zip | 17033-0858
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Country | US
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Telephone | 800-243-1455
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0058359
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MDD30059
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101055431
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD445541
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License Number State | PA
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