Provider Demographics
NPI:1629056114
Name:DIETLY, ROBIN Z (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:Z
Last Name:DIETLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 LATHROP STREET
Mailing Address - Street 2:SUITE 9055 FORBES TOWER
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2536
Mailing Address - Country:US
Mailing Address - Phone:412-647-3087
Mailing Address - Fax:412-647-4050
Practice Address - Street 1:9104 BABCOCK BLVD
Practice Address - Street 2:SUITE 1106
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237
Practice Address - Country:US
Practice Address - Phone:412-366-6841
Practice Address - Fax:412-366-8650
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027522E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADI170691OtherHIGHMARK
PA103805800005Medicaid
PA103805800005Medicaid
PA170691Medicare PIN
PA170691P7QMedicare ID - Type Unspecified