Provider Demographics
NPI:1396810826
Name:MALCOLM H. DIETRICH D.O. LTD
Entity type:Organization
Organization Name:MALCOLM H. DIETRICH D.O. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:DIETRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-843-4844
Mailing Address - Street 1:1300 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-1251
Mailing Address - Country:US
Mailing Address - Phone:717-843-4844
Mailing Address - Fax:717-854-5288
Practice Address - Street 1:1300 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-1251
Practice Address - Country:US
Practice Address - Phone:717-843-4844
Practice Address - Fax:717-854-5288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002279L207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB96647Medicare UPIN
PA041680Medicare ID - Type Unspecified