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General NPI Number Information
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NPI Number | 1871823591
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Entity Type | Organization
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Legal Business Name | DIEHL PLASTIC SURGERY, PLLC
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Dates
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Enumeration Date | 12/31/2009
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Last Update Date | 12/31/2009
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Provider Practice Location Address
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Address Line | 9636 CLUB VALLEY WAY
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City | RALEIGH
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State | NC
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Zip | 27617-8604
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Country | US
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Telephone | 919-237-1097
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Fax | 919-873-9244
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Provider Business Mailing Address
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Address Line | 9636 CLUBVALLEY WAY
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City | RALEIGH
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State | NC
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Zip | 27617-8604
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Country | US
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Telephone | 919-237-1097
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Fax | 919-873-9244
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Authorized Official
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Title or Position | PRESIDENT
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Name | CYNTHIA L DIEHL
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Credential | MD
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Telephone | 919-237-1097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1972575850
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License Number State | NC
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