Provider Demographics
NPI:1033160387
Name:FRIEDMAN, DIANE E (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:E
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 GALISTEO ST
Mailing Address - Street 2:SUITE N9A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2143
Mailing Address - Country:US
Mailing Address - Phone:505-988-1930
Mailing Address - Fax:505-982-9931
Practice Address - Street 1:2019 GALISTEO ST
Practice Address - Street 2:SUITE N9A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2143
Practice Address - Country:US
Practice Address - Phone:505-988-1930
Practice Address - Fax:505-982-9931
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99-200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM009P17OtherBLUE CROSS BLUE SHIELD
NM53199OtherPRESBYTERIAN
NM54700833Medicaid
NMG35808Medicare UPIN
NM54700833Medicaid