Provider Demographics
NPI:1003817008
Name:GABLE, DIANE M (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:GABLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:M
Other - Last Name:GABLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, LLC
Mailing Address - Street 1:15 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-5364
Mailing Address - Country:US
Mailing Address - Phone:207-872-0533
Mailing Address - Fax:207-873-3428
Practice Address - Street 1:15 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-5364
Practice Address - Country:US
Practice Address - Phone:207-872-0533
Practice Address - Fax:207-873-3428
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012113208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME027880OtherBCBS
ME027880OtherBCBS
MEMMGA2648Medicare ID - Type Unspecified