Provider Demographics
NPI:1154823284
Name:MCEWEN, DIANE MARYLIN (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARYLIN
Last Name:MCEWEN
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 1:12 OLD LANDING RD
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1110
Mailing Address - Country:US
Mailing Address - Phone:415-990-1249
Mailing Address - Fax:
Practice Address - Street 1:12 OLD LANDING RD
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-1110
Practice Address - Country:US
Practice Address - Phone:415-990-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA226412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry