Individual
ANN MARIE DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
701 GROVE RD FL 1, GREENVILLE, SC 29605-4210
(864) 455-7899
(864) 455-5474
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
86478
SC
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
35055079
OH
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
86478
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0105570000
—
WV
05
—
2028273
—
OH
05
—
6486614800
—
KY
05
—
PENDING
—
SC
Enumeration date
08/10/2005
Last updated
05/02/2022
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