Provider Demographics
NPI:1467466623
Name:DIEHN, KARL W (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:W
Last Name:DIEHN
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 1:6565 N CHARLES ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6800
Mailing Address - Country:US
Mailing Address - Phone:410-821-5151
Mailing Address - Fax:410-823-8309
Practice Address - Street 1:6565 N CHARLES ST
Practice Address - Street 2:SUITE 601
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6800
Practice Address - Country:US
Practice Address - Phone:410-821-5151
Practice Address - Fax:410-823-8309
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019874174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB66933Medicare UPIN
MDH522Medicare ID - Type Unspecified