MEDICARE: DIETRICH W.L. SCHULTZE 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	2085R0204X	Vascular & Interventional Radiology Physician	269283	MA
2	2085R0202X	Diagnostic Radiology Physician	ME132409	FL
3	2085R0204X	Vascular & Interventional Radiology Physician	57177	CT

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922192459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIETRICH W.L. SCHULTZE M.D.

Provider Business Mailing Address
First Line	:	960 MASSACHUSETTS AVE
Second Line	:	FL 2
City	:	BOSTON
State	:	MA
Zip	:	02118-2690
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	736 CAMBRIDGE ST
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135
Country	:	US
Telephone Number	:	617-789-2762
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/23/2026

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