Provider Demographics
NPI:1306858188
Name:DIEHL, COURTENAY L (MD)
Entity Type:Individual
Prefix:
First Name:COURTENAY
Middle Name:L
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 1:33 CHANDLER AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1684
Mailing Address - Country:US
Mailing Address - Phone:585-344-4700
Mailing Address - Fax:585-344-5454
Practice Address - Street 1:33 CHANDLER AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1684
Practice Address - Country:US
Practice Address - Phone:585-344-4700
Practice Address - Fax:585-344-5454
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48600207VX0000X
NY253736-1207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03124816Medicaid
I57724Medicare UPIN
NY03124816Medicaid