Provider Demographics
NPI:1902872971
Name:DIENER, JAKOW (MD)
Entity Type:Individual
Prefix:
First Name:JAKOW
Middle Name:
Last Name:DIENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:NH
Mailing Address - Zip Code:03574-4342
Mailing Address - Country:US
Mailing Address - Phone:603-616-9916
Mailing Address - Fax:
Practice Address - Street 1:360 BROOK RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:NH
Practice Address - Zip Code:03574-4342
Practice Address - Country:US
Practice Address - Phone:603-616-9916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12255207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80300008Medicaid
NH5414126OtherCIGNA HEALTHCARE
NH384132OtherMVP
VT1010617Medicaid
NHAA38042OtherHARVARD PILGRIM HEALTHCAR
OH0196371Medicaid
NH01Y007264NH01OtherBLUE CROSS/BLUE SHIELD
NHAA38042OtherHARVARD PILGRIM HEALTHCAR
NH01Y007264NH01OtherBLUE CROSS/BLUE SHIELD
OH0196371Medicaid