MEDICARE: DR. EARL H. DIEHL 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	174400000X	Specialist	0101029248	VA

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	:	1750382123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EARL H. DIEHL M.D.

Provider Business Mailing Address
First Line	:	107 WADSWORTH DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23236-4521
Country	:	US
Telephone Number	:	804-330-4901
Fax Number	:	804-330-9142

Provider Business Practice Location Address
First Line	:	110 N ROBINSON ST
Second Line	:	SUITE 300
City	:	RICHMOND
State	:	VA
Zip	:	23220-4459
Country	:	US
Telephone Number	:	804-353-4916
Fax Number	:	804-254-5216

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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