Individual
DR. MICHAEL F DIFFENDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3332 PAPER MILL RD, PHOENIX, MD 21131-1419
(410) 628-1510
(410) 628-1511
Mailing address
3714 TUDOR ARMS AVE, BALTIMORE, MD 21211-2246
(410) 366-0165
(301) 352-3568
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TA1372
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1086642
MAMSI
MD
05
—
403626300
—
MD
01
—
67500005
BLUE CROSS CAREFIRST
DC
Enumeration date
06/14/2006
Last updated
10/30/2013
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