Individual
MEGAN ELIZABETH DIETERICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
175 W PARK AVE, NEW HAVEN, CT 06511-2928
(617) 538-7207
Mailing address
175 W PARK AVE, NEW HAVEN, CT 06511-2928
(617) 538-7207
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA030671
DC
Other
Enumeration date
04/12/2010
Last updated
04/12/2010
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