Provider Demographics
NPI:1598023376
Name:WATERMAN, DIEDRICH COLLINS (MD)
Entity Type:Individual
Prefix:DR
First Name:DIEDRICH
Middle Name:COLLINS
Last Name:WATERMAN
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 1:116 BASKERVILL DR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-6185
Mailing Address - Country:US
Mailing Address - Phone:843-237-2672
Mailing Address - Fax:843-237-0369
Practice Address - Street 1:116 BASKERVILL DR
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-6185
Practice Address - Country:US
Practice Address - Phone:843-237-2672
Practice Address - Fax:843-237-0369
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD34481207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology