Basic Information
| Provider Information | |||||||||
| NPI: | 1972918647 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIEHL | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1810 E MONUMENT ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212052107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105025735 | ||||||||
| FaxNumber: | 4105025734 | ||||||||
| Practice Location | |||||||||
| Address1: | 1810 E MONUMENT ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212052107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105025735 | ||||||||
| FaxNumber: | 4105025734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2014 | ||||||||
| LastUpdateDate: | 07/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 20750 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.