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NPI Code Detail

MEDICARE: DIANNE ALAIA FETCHICK M.D.

MEDICARE: DIANNE ALAIA FETCHICK 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
1207RE0101XEndocrinology, Diabetes & Metabolism PhysicianG2961TX

Other Identifiers

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

General Provider Information

NPI Number : 1770665465
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANNE ALAIA FETCHICK M.D.
Provider Business Mailing Address
First Line : 7863 CALLAGHAN RD
Second Line : SUITE 206
City : SAN ANTONIO
State : TX
Zip : 78229-2453
Country : US
Telephone Number : 866-693-4223
Fax Number : 888-237-7954
Provider Business Practice Location Address
First Line : 13171 MISTY WILLOW DR
Second Line :
City : HOUSTON
State : TX
Zip : 77070-5635
Country : US
Telephone Number : 866-693-4223
Fax Number : 888-237-7954
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 01/31/2012

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