Dieterich, Steven R

Dieterich, Steven R is an individual health care provider with primary practice located at 13 Church Rd , East Granby CT 06026-0518. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Dieterich, Steven R can be contacted via phone (860) 653-4526.

Contact Information

Primary practice address
13 Church Rd East Granby CT 06026-0518
Phone: (860) 653-4526
Fax: (860) 653-5209
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 018693 Connecticut

Profile Details

NPI number 1063499127
LBN Legal business name Dieterich, Steven R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 29th, 2005
Last updated Jan 18th, 2011 - about 14 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063499127 NPPES
Connecticut Other 140065 AETNA
Connecticut MEDICAID 001186931 AETNA
Connecticut Other 010018693CT01 AETNA
Connecticut Other 0104402 AETNA
Connecticut Other 018693 AETNA
Connecticut Other HAP210 AETNA
Connecticut Other 2085328005 AETNA
Connecticut Other 0P0372 AETNA

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