Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ML20008453 | WA |
N | 2080P0202X | Pediatric Cardiologist | MD448317 | PA |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD448317 | PA |
NPI | 1265548994 |
---|---|
Provider Name | John Wesley Diddle |
First Address | Pittsburgh, PA 15224-1334 |
Second Address | Pittsburgh, PA 15224-1334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 03/05/2015 |