Provider Demographics
NPI:1518942168
Name:DIEDRICH, WILLIAM ARNOLD (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ARNOLD
Last Name:DIEDRICH
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 1:320 LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-2128
Mailing Address - Country:US
Mailing Address - Phone:614-873-5041
Mailing Address - Fax:614-873-5041
Practice Address - Street 1:320 LANTERN LN
Practice Address - Street 2:
Practice Address - City:PLAIN CITY
Practice Address - State:OH
Practice Address - Zip Code:43064-2128
Practice Address - Country:US
Practice Address - Phone:614-873-5041
Practice Address - Fax:614-873-5041
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.088724207ZP0102X
PAMD440611207ZP0102X
IN01068477A207ZP0102X
DEC1-0002979207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDI4192852Medicare PIN
OH4192852Medicare PIN
OHE60124Medicare UPIN