Individual
DIETRICH GRAVENSTEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 S 11TH ST STE 8490, PHILADELPHIA, PA 19107-4824
(215) 955-6161
(215) 923-5507
Mailing address
111 S 11TH ST STE 8490, PHILADELPHIA, PA 19107-4824
(215) 955-6161
(215) 923-5507
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD451666
PA
207L00000X
Anesthesiology Physician
ME64324
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
372840400
—
FL
Enumeration date
07/16/2006
Last updated
11/26/2018
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