Provider Demographics
NPI:1518386796
Name:DIETZ, DONALD ELMORE IV (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ELMORE
Last Name:DIETZ
Suffix:IV
Gender:M
Credentials:MD
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Mailing Address - Street 1:525 EAST 68TH STREET
Mailing Address - Street 2:STARR BUILDING, 5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:212-746-4071
Mailing Address - Fax:212-746-4734
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:STARR BUILDING, 5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-9800
Practice Address - Country:US
Practice Address - Phone:212-746-4071
Practice Address - Fax:212-746-4734
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2023-08-18
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Provider Licenses
StateLicense IDTaxonomies
CAA149185207R00000X, 208M00000X
NY282473208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine