Provider Demographics
NPI:1437134608
Name:DIEHL, SCOTT JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JORDAN
Last Name:DIEHL
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 1:305 RIVERWAY PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6764
Mailing Address - Country:US
Mailing Address - Phone:603-669-2779
Mailing Address - Fax:603-669-2190
Practice Address - Street 1:305 RIVERWAY PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6764
Practice Address - Country:US
Practice Address - Phone:603-669-2779
Practice Address - Fax:603-669-2190
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-10
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHDINH0116Medicare ID - Type Unspecified
NHB85842Medicare UPIN