Provider Demographics
NPI:1174502298
Name:DIEHL, RODNEY O (DO)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:O
Last Name:DIEHL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 MCFARLAND ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3977
Mailing Address - Country:US
Mailing Address - Phone:423-492-5450
Mailing Address - Fax:
Practice Address - Street 1:705 MCFARLAND ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3977
Practice Address - Country:US
Practice Address - Phone:423-492-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012144207RC0000X, 207RI0011X
TN4025207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3463721Medicaid
TNQ059292Medicaid