Provider Demographics
NPI:1821634585
Name:DIEHL, IAN JOEL (PA-C)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:JOEL
Last Name:DIEHL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7531
Mailing Address - Country:US
Mailing Address - Phone:272-212-0620
Mailing Address - Fax:
Practice Address - Street 1:1581 N 9TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7531
Practice Address - Country:US
Practice Address - Phone:272-212-0620
Practice Address - Fax:833-485-0134
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027578225100000X
PAMA063965363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist