Provider Demographics
NPI:1073547030
Name:DIETRICH, DINUSHA W (MD)
Entity Type:Individual
Prefix:DR
First Name:DINUSHA
Middle Name:W
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SMITH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1700
Mailing Address - Country:US
Mailing Address - Phone:401-231-3138
Mailing Address - Fax:401-231-4757
Practice Address - Street 1:7 SMITH AVE STE 103
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-1700
Practice Address - Country:US
Practice Address - Phone:401-231-3138
Practice Address - Fax:401-231-4757
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10951208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDD47929Medicaid
H76525Medicare UPIN