=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487879540
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES BOYD DIEHL CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CUMBERLAND ANESTHESIA AND PAIN MANAGMENT 600 MEMORIAL AVE.
-----------------------------------------------------
City | CUMBERLAND
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-723-4965
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11507 WEST WILSON ROAD NE
-----------------------------------------------------
City | FLINTSTONE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-777-3531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | R130257
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------