Individual
CHARLES L DIETZEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1101 WHITE HORSE RD, SUITE C, VOORHEES, NJ 08043-2157
(856) 309-9777
Mailing address
1101 WHITE HORSE RD, SUITE C, VOORHEES, NJ 08043-2157
(856) 309-9777
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
MB46719
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0375209
—
NJ
Enumeration date
08/18/2006
Last updated
05/29/2018
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