MEDICARE: WILLIAM ARNOLD DIEDRICH 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	35.088724	OH
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD440611	PA
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	01068477A	IN
4	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	C1-0002979	DE

General Provider Information

NPI Number	:	1518942168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM ARNOLD DIEDRICH MD

Provider Business Mailing Address
First Line	:	320 LANTERN LN
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-2128
Country	:	US
Telephone Number	:	614-873-5041
Fax Number	:	614-873-5041

Provider Business Practice Location Address
First Line	:	320 LANTERN LN
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-2128
Country	:	US
Telephone Number	:	614-873-5041
Fax Number	:	614-873-5041

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	01/16/2011

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