Provider Demographics
NPI:1871823591
Name:DIEHL PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:DIEHL PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-237-1097
Mailing Address - Street 1:9636 CLUBVALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8604
Mailing Address - Country:US
Mailing Address - Phone:919-237-1097
Mailing Address - Fax:919-873-9244
Practice Address - Street 1:9636 CLUB VALLEY WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8604
Practice Address - Country:US
Practice Address - Phone:919-237-1097
Practice Address - Fax:919-873-9244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1972575850174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty