MEDICARE: DR. ANTHONY PAUL DIETRICH 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	2084P0800X	Psychiatry Physician	2009-00644	NC
2	2084P0800X	Psychiatry Physician	042-0008490	VT

General Provider Information

NPI Number	:	1710981741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY PAUL DIETRICH MD

Provider Business Mailing Address
First Line	:	114 BERRY CREEK DR
Second Line	:
City	:	FLAT ROCK
State	:	NC
Zip	:	28731-8531
Country	:	US
Telephone Number	:	828-697-0333
Fax Number	:	828-697-0375

Provider Business Practice Location Address
First Line	:	114 BERRY CREEK DR
Second Line	:
City	:	FLAT ROCK
State	:	NC
Zip	:	28731-8531
Country	:	US
Telephone Number	:	828-697-0333
Fax Number	:	828-697-0375

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	05/24/2009

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