Provider Demographics
NPI:1033286471
Name:MEISBURGER, DIANA LEIGH (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LEIGH
Last Name:MEISBURGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 WATERS EDGE DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2484
Mailing Address - Country:US
Mailing Address - Phone:919-851-3002
Mailing Address - Fax:919-851-9127
Practice Address - Street 1:4904 WATERS EDGE DR
Practice Address - Street 2:SUITE 240
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2484
Practice Address - Country:US
Practice Address - Phone:919-851-3002
Practice Address - Fax:919-851-9127
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2154174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000788Medicaid