Provider Demographics
NPI:1043386303
Name:DIEHL, BRIDGET ANN (PAC)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:ANN
Last Name:DIEHL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 NORRISVILLE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1419
Mailing Address - Country:US
Mailing Address - Phone:410-692-5292
Mailing Address - Fax:
Practice Address - Street 1:3718 NORRISVILLE RD
Practice Address - Street 2:SUITE C
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084-1419
Practice Address - Country:US
Practice Address - Phone:410-692-5292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003433363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD891LMedicare ID - Type Unspecified