Provider Demographics
NPI:1043466030
Name:CARVAJAL, DIANA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:NICOLE
Last Name:CARVAJAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 64380
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4380
Mailing Address - Country:US
Mailing Address - Phone:410-328-6792
Mailing Address - Fax:410-328-8726
Practice Address - Street 1:29 S PACA ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1771
Practice Address - Country:US
Practice Address - Phone:410-328-2616
Practice Address - Fax:140-328-8726
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine