Provider Demographics
NPI:1629184239
Name:DIEHL, MEREDITH LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LEIGH
Last Name:DIEHL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:DIEHL
Other - Last Name:BRENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3855 GASKINS RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1441
Mailing Address - Country:US
Mailing Address - Phone:804-290-4278
Mailing Address - Fax:804-217-6400
Practice Address - Street 1:3855 GASKINS RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1441
Practice Address - Country:US
Practice Address - Phone:804-217-6363
Practice Address - Fax:804-217-6400
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241405207WX0109X
MOT2004009604207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1629184239Medicaid
302628OtherHEALTHKEEPERS
302628OtherANTHEM
VA7208981OtherAETNA
2168499OtherUNITED HEALTH CARE
1629184239OtherVA PREMIER
10022943OtherOPTIMA
014324V49OtherMEDICARE
2168499OtherMD IPA
302628OtherHEALTHKEEPERS
1629184239OtherVA PREMIER
VA1629184239Medicaid