Jordan Dietrich, MD is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Lebanon, New Hampshire. His current practice location is
1 Medical Dr Dept Of, Lebanon, New Hampshire. You can reach out to his office (for appointments etc.) via phone at
(603) 650-5000.
Jordan Dietrich is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1255081345.
Physician's Profile
Full Name | Jordan Dietrich |
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Gender | Male |
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Speciality | Student In An Organized Health Care Education/training Program |
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Location | 1 Medical Dr Dept Of, Lebanon, New Hampshire |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1255081345
- Provider Enumeration Date: 03/24/2022
- Last Update Date: 11/06/2024
Medicare PECOS Information:
- PECOS PAC ID: 6507247673
- Enrollment ID: I20220720002902
Medical Identifiers
Medical identifiers for Jordan Dietrich such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1255081345 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
2084P0800X | Psychiatry & Neurology - Psychiatry | 33439 (New Hampshire) | Secondary |
390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jordan Dietrich is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Jordan Dietrich, MD 1 Medical Dr Dept Of, Lebanon, NH 03756-1000 Ph: () - | Jordan Dietrich, MD 1 Medical Dr Dept Of, Lebanon, NH 03756-1000 Ph: (603) 650-5000 |
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