Provider Demographics
NPI:1174690242
Name:TIEDRICH, ALLAN DON (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:DON
Last Name:TIEDRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 SOUTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062
Mailing Address - Country:US
Mailing Address - Phone:908-769-7999
Mailing Address - Fax:908-769-5816
Practice Address - Street 1:1304 SOUTH AVENUE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07062
Practice Address - Country:US
Practice Address - Phone:908-769-7999
Practice Address - Fax:908-769-5816
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41589208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation