MEDICARE: DAVID DIDDEN M.D.

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	207Q00000X	Family Medicine Physician	21679	WV

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

General Provider Information

NPI Number	:	1659375905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DIDDEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1411
Second Line	:
City	:	SHEPHERDSTOWN
State	:	WV
Zip	:	25443-1411
Country	:	US
Telephone Number	:	304-579-4746
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 BIRD NEST WAY
Second Line	:
City	:	SHEPHERDSTOWN
State	:	WV
Zip	:	25443-3734
Country	:	US
Telephone Number	:	304-995-8240
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/06/2025

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