Provider Demographics
NPI:1073535183
Name:POHL, DIETER (MD)
Entity Type:Individual
Prefix:DR
First Name:DIETER
Middle Name:
Last Name:POHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1539 ATWOOD AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919
Mailing Address - Country:US
Mailing Address - Phone:401-521-6310
Mailing Address - Fax:401-861-9596
Practice Address - Street 1:RHODE ISLAND SURGEONS INC
Practice Address - Street 2:1539 ATWOOD AVE SUITE 201
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919
Practice Address - Country:US
Practice Address - Phone:401-521-6310
Practice Address - Fax:401-861-9596
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIRI10176208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRI10176OtherRI LICENSE
RI9002872Medicaid
RI9002872Medicaid