MEDICARE: DR. CHARLES DINERSTEIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	MA048088	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255336715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES DINERSTEIN MD

Provider Business Mailing Address
First Line	:	PO BOX 300
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-0300
Country	:	US
Telephone Number	:	717-270-7780
Fax Number	:	717-274-9746

Provider Business Practice Location Address
First Line	:	4TH & WALNUT STREETS
Second Line	:	2ND FLOOR
City	:	LEBANON
State	:	PA
Zip	:	17042-6123
Country	:	US
Telephone Number	:	717-270-3751
Fax Number	:	270-270-3754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	12/03/2014

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