Provider Demographics
NPI:1245213933
Name:DIEHL, KRISTINE B (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:B
Last Name:DIEHL
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 1:2700 SILVERSIDE RD
Mailing Address - Street 2:STE 2
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3719
Mailing Address - Country:US
Mailing Address - Phone:302-478-8421
Mailing Address - Fax:302-478-8422
Practice Address - Street 1:2700 SILVERSIDE RD
Practice Address - Street 2:STE 2
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3719
Practice Address - Country:US
Practice Address - Phone:302-478-8421
Practice Address - Fax:302-478-8422
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004693173000000X
DEC1-0004693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE510374122OtherALL OTHER INSURANCE CO
DE861863Medicare ID - Type Unspecified