Basic Information
| Provider Information | |||||||||
| NPI: | 1548336803 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIETRICH | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | LAROY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 E JEFFERSON ST | ||||||||
| Address2: | KAISER PERMANENTE MEDICAIRE ENROLLMENT | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018162424 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4920 CAMPBELL BLVD | ||||||||
| Address2: | KAISER PERMANENTE WHITE MARSH MEDICAL CENTER | ||||||||
| City: | NOTTINGHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212365916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109337600 | ||||||||
| FaxNumber: | 4109337802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 11/25/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | D0026218 | MD | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 0101221514 | VA | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.