MEDICARE: DR. MARIA S FLORES DIEPPA 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	25MA04500700	NJ

General Provider Information

NPI Number	:	1851399604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA S FLORES DIEPPA M.D.

Provider Business Mailing Address
First Line	:	616 GROVE AVE
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-3212
Country	:	US
Telephone Number	:	732-548-6303
Fax Number	:	732-548-9822

Provider Business Practice Location Address
First Line	:	616 GROVE AVE
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-3212
Country	:	US
Telephone Number	:	732-548-6303
Fax Number	:	732-548-9822

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	04/02/2014

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