Provider Demographics
NPI:1700891264
Name:DIETL, CHARLES (MD)
Entity Type:Individual
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First Name:CHARLES
Middle Name:
Last Name:DIETL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:2ND AMBULATORY CARE CTR
Practice Address - Street 2:2211 LOMAS BLVD. NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-6901
Practice Address - Fax:505-272-6909
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2012-05-18
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Provider Licenses
StateLicense IDTaxonomies
NM99-188208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)