GARY D DIEDERICH M.D. NPI 1720029259

NPI Information

  • NPI: 1720029259
  • Provider Name: GARY D DIEDERICH, M.D.
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 859 LAKE ST
    BRISTOL, NH
    ZIP 03222
  • Phone: (603) 744-6200

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NPI Details

Gary D Diederich, M.D. is a family medicine in Bristol, NH. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. Gary D Diederich, M.D. NPI is 1720029259. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

859 LAKE ST
BRISTOL, NH
ZIP 03222-506
Phone: (603) 744-6200
Fax: (603) 744-9024

The NPI 1720029259 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/8/2006 and was last updated on 11/30/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily Medicine6515NEW HAMPSHIREYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1B85860MEDICARE UPINNEW HAMPSHIRE
2NH0321MEDICARE OSCAR/CERTIFICATIONNEW HAMPSHIRE
380000321MEDICAIDNEW HAMPSHIRE
4RE4060OTHERNEW HAMPSHIREMEDICARE GROUP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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