GARY D DIEDERICH (NPI# 1720029259) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720029259 |
| Entity Type | Individual |
| Full Name | GARY D DIEDERICH |
| Credential | M.D. |
| Practice Address |
859 Lake St Bristol NH 03222-4506 |
| Mailing Address |
101 Boulder Point Dr Suite 1 Plymouth NH 03264 |
| Practice Telephone | 6037446200 |
| Practice Fax Number | 6037449024 |
| Mailing Telephone | 6035364000 |
| Mailing Fax Number | 6035364001 |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2007-11-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 6515 | NH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NH | MEDICARE GROUP | RE4060 | 01 |
| NH | 80000321 | 05 |
| Street Address |
859 LAKE ST |
| City | BRISTOL |
| State | NH |
| Zip Code | 03222-4506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912166083 | Mid-state Health Center | Family Medicine | 859 Lake St, Bristol, NH 03222-4506 | 2008-06-04 |
| 1225154065 | Mid-state Health Center | Family Medicine | 859 Lake St, Bristol, NH 03222-4506 | 2007-03-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316247596 | Janice E Vaughn | Nurse Practitioner | 5 School St, Bristol, NH 03222 | 2010-10-22 |
| 1831161470 | Bristol Imaging PC | Radiology | 225 Hemphill Rd Bristol Imaging PC, Bristol, NH 03222-0513 | 2006-02-07 |
| 1689733644 | Rexford Forrest Burnette | Psychologist | 5 Pleasant St., Suite A, Bristol, NH 03222-3002 | 2006-12-06 |
| 1518510940 | Shanna Fielding | Physician Assistant | 181 Prospect St, Bristol, NH 03222-3021 | 2019-07-24 |
| 1881100022 | Mccleary Assisted Living Services LLC | Assisted Living Facility | 212 Summer St, Bristol, NH 03222-3208 | 2017-12-26 |
| 1447578034 | Thomas Clifford White | Pharmacist | 360 Summer St, Bristol, NH 03222-3213 | 2010-05-07 |
| 1750490165 | Rite Aid of New Hampshire Inc | Durable Medical Equipment & Medical Supplies | 360 Summer Street, Bristol, NH 03222-3213 | 2006-08-30 |
| 1912416447 | Ehimen Aisaborhale | Pharmacist | 360 Summer St, Bristol, NH 03222-3213 | 2017-09-27 |
| 1508274556 | Tina Easley | Pharmacist | 360 Summer St, Bristol, NH 03222-3213 | 2014-07-22 |
| 1184694804 | Peter G Doane | Family Medicine | 5 School St, Bristol, NH 03222-3263 | 2006-01-25 |
| Find all providers in zip 03222 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871840843 | Five-town Health Alliance, Inc | Family Medicine | 61 Pine Street, Building 4, Bristol, VT 05443 | 2012-08-09 |
| 1417214537 | Leonard Davidson | Family Medicine | 202 Jefferson Ave, Bristol, PA 19007 | 2012-04-13 |
| 1760758734 | Renee Bratspis | Family Medicine | 74 Munsill Ave Ste 100, Bristol, VT 05443-1047 | 2012-03-23 |
| 1013288810 | Medical Education Assistance Corporation | Family Medicine | 826 Meadow View Rd, Bristol, TN 37620 | 2012-01-25 |
| 1780829572 | David Lynn Stevens | Family Medicine | 504 Old Jonesboro Rd, Bristol, TN 37620-5670 | 2008-12-08 |
| 1285892299 | Natasha Alexa Withers | Family Medicine | 61 Pine St Ste 400, Bristol, VT 05443-1043 | 2008-05-27 |
| 1992901409 | Uzoma N Obuekwe | Family Medicine | 2001 Euclid Ave, Bristol, VA 24201-3609 | 2007-06-22 |
| 1750502514 | Ronna Denise New | Family Medicine | 1 Medical Park Blvd Ste 450w, Bristol, TN 37620-7470 | 2007-05-01 |
| 1063552461 | Carol A Dewey | Family Medicine | 522 Alabama St, Bristol, TN 37620-2307 | 2007-02-07 |
| 1093898702 | J Scott Ries | Family Medicine | 504 Old Jonesboro Road, Bristol, TN 37620 | 2006-10-24 |
| Find all providers in BRISTOL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.