Individual
DR. CLIFTON DIETRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
169 ASHLEY AVE RM 202, CHARLESTON, SC 29425-8905
(724) 831-9949
Mailing address
169 ASHLEY AVE RM 202, CHARLESTON, SC 29425-8905
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
LL90355
SC
Other
Enumeration date
06/28/2023
Last updated
06/28/2023
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