Diederich, Gary D
Diederich, Gary D is an individual health care provider with primary practice located at 859 Lake St , Bristol NH 03222-4506. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Diederich, Gary D can be contacted via phone (603) 744-6200.Contact Information
Primary practice address
859 Lake St
Bristol NH 03222-4506
Phone: (603) 744-6200
Fax: (603) 744-9024
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 6515 | New Hampshire |
Profile Details
| NPI number | 1720029259 |
|---|---|
| LBN Legal business name | Diederich, Gary D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 8th, 2006 |
| Last updated | Nov 30th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720029259 | NPPES |
| New Hampshire | MEDICAID | 80000321 | |
| New Hampshire | Other | RE4060 |
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