Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 5239 | SC |
NPI | 1023067683 |
---|---|
Provider Name | Diedreich P Von Lehe JR. |
First Address | Ladson, SC 29456-4304 |
Second Address | Ladson, SC 29456-4304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 09/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
052392 | (05) | SC |
D18339 | (02) | SC |