Provider Demographics
NPI:1053479261
Name:KING, DIANE L (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:KING
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 1:550 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3027
Mailing Address - Country:US
Mailing Address - Phone:540-316-5940
Mailing Address - Fax:540-316-5941
Practice Address - Street 1:6200 STATION DR
Practice Address - Street 2:
Practice Address - City:BEALETON
Practice Address - State:VA
Practice Address - Zip Code:22712-9374
Practice Address - Country:US
Practice Address - Phone:540-439-8100
Practice Address - Fax:540-439-8797
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045014207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005613230Medicaid
E23186Medicare UPIN
VA005613230Medicaid