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General NPI Number Information
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NPI Number | 1689973067
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Entity Type | Organization
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Legal Business Name | DAVID F. DIETEMAN, MD, INC.
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 3190 GLENWOOD PARK AVE
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City | ERIE
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State | PA
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Zip | 16508-2746
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Country | US
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Telephone | 814-459-2726
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Fax |
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Provider Business Mailing Address
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Address Line | 3190 GLENWOOD PARK AVE
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City | ERIE
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State | PA
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Zip | 16508-2746
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Country | US
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Telephone | 814-459-2726
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID F. DIETEMAN
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Credential | MD
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Telephone | 814-459-2726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD013236E
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License Number State | PA
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