Kathy M Dietlin, MD

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

78175 Issued in MA

Practice address

49 State Road
Watuppa Building Suite 203
North Dartmouth, MA 02747-3300

Phone

(508) 994-0120

Fax

(508) 996-9636

NPI assigned

Mar 18, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1699734756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 STATE ROAD",
            "address_2": "WATUPPA BUILDING SUITE 203",
            "city": "NORTH DARTMOUTH",
            "state": "MA",
            "postal_code": "027473300",
            "telephone_number": "508-994-0120",
            "fax_number": "508-996-9636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 STATE ROAD",
            "address_2": "WATUPPA BUILDING SUITE 203",
            "city": "NORTH DARTMOUTH",
            "state": "MA",
            "postal_code": "027473300",
            "telephone_number": "508-994-0120",
            "fax_number": "508-996-9636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETLIN",
        "first_name": "KATHY",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-18",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "MA",
            "license": "78175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3118061",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Allergy & Immunology Physician in North Dartmouth, MA
• Providers in North Dartmouth, MA by specialty
• Allergy & Immunology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.