Provider Demographics
NPI:1710981741
Name:DIETRICH, ANTHONY PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:PAUL
Last Name:DIETRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:114 BERRY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731-8531
Mailing Address - Country:US
Mailing Address - Phone:828-697-0333
Mailing Address - Fax:828-697-0375
Practice Address - Street 1:114 BERRY CREEK DR
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-8531
Practice Address - Country:US
Practice Address - Phone:828-697-0333
Practice Address - Fax:828-697-0375
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2009-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-006442084P0800X
VT042-00084902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DI-VN0297Medicare UPIN