Provider Demographics
NPI:1114077096
Name:LEARN, DIANE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:LEARN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:264 TILGHMAN RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1921
Mailing Address - Country:US
Mailing Address - Phone:443-260-2660
Mailing Address - Fax:443-260-2660
Practice Address - Street 1:264 TILGHMAN RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1921
Practice Address - Country:US
Practice Address - Phone:410-742-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC01277363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPA62418OtherCDS
MDC01277OtherLICENSE
MDC01277OtherLICENSE
MDQ78777Medicare UPIN
MDQ050Medicare PIN