Provider Demographics
NPI:1689973067
Name:DAVID F. DIETEMAN, MD, INC.
Entity Type:Organization
Organization Name:DAVID F. DIETEMAN, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:DIETEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-459-2726
Mailing Address - Street 1:3190 GLENWOOD PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2746
Mailing Address - Country:US
Mailing Address - Phone:814-459-2726
Mailing Address - Fax:
Practice Address - Street 1:3190 GLENWOOD PARK AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2746
Practice Address - Country:US
Practice Address - Phone:814-459-2726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013236E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty