Basic Information
| Provider Information | |||||||||
| NPI: | 1881784171 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIEHL | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | CARL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2633 ARBOR PARK | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430557054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143063569 | ||||||||
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| Practice Location | |||||||||
| Address1: | 575 COPELAND MILL RD STE 1D | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430818977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147940481 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2006 | ||||||||
| LastUpdateDate: | 01/16/2015 | ||||||||
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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 | 363A00000X | 2532 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.