Provider Demographics
NPI:1083613913
Name:BAKER, DIANE ROMAYNE (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:ROMAYNE
Last Name:BAKER
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 1:9495 SW LOCUST ST STE A&E
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6683
Mailing Address - Country:US
Mailing Address - Phone:503-471-0500
Mailing Address - Fax:503-471-0504
Practice Address - Street 1:9495 SW LOCUST ST STE A&E
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-6683
Practice Address - Country:US
Practice Address - Phone:503-471-0500
Practice Address - Fax:503-471-0504
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08916207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C92140Medicare UPIN
C92140Medicare UPIN