Provider Demographics
NPI:1265425623
Name:DIETERICH, JANA B (PA-C)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:B
Last Name:DIETERICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-0183
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:1255 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 1200
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6256
Practice Address - Country:US
Practice Address - Phone:610-437-6222
Practice Address - Fax:610-437-5910
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA051165363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA091335Medicare ID - Type Unspecified
PAQ44701Medicare UPIN