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Individual

STEVEN R DIETERICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
13 CHURCH RD, EAST GRANBY, CT 06026-0518
(860) 653-4526
(860) 653-5209
Mailing address
PO BOX 518, 13 CHURCH RD, EAST GRANBY, CT 06026-0518
(860) 653-4526
(860) 653-5209

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
018693
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001186931
CT
01
010018693CT01
BCBS
CT
01
0104402
UNITED
CT
01
018693
CT
CT
01
0P0372
HEALTHNET
CT
01
140065
AETNA
CT
01
2085328005
CIGNA
CT
01
HAP210
OXFORD
CT
Enumeration date
12/29/2005
Last updated
01/18/2011
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