Provider Demographics
NPI:1679318752
Name:DIEDRICH, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DIEDRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BELLEMORE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1314
Mailing Address - Country:US
Mailing Address - Phone:808-366-7980
Mailing Address - Fax:
Practice Address - Street 1:117 BELLEMORE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1314
Practice Address - Country:US
Practice Address - Phone:808-366-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program