Provider Demographics
NPI:1407928872
Name:DIETZLER, ROXANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:DIETZLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HILTON TERRACE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601
Mailing Address - Country:US
Mailing Address - Phone:757-596-5605
Mailing Address - Fax:757-596-5605
Practice Address - Street 1:732 THIMBLE SHOALS BLVD
Practice Address - Street 2:STE 102
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-599-3623
Practice Address - Fax:757-599-1819
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102049994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine