Provider Demographics
NPI:1194825059
Name:MUCHANT, DIANNE G (MD)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:G
Last Name:MUCHANT
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-1339
Practice Address - Country:US
Practice Address - Phone:570-271-6440
Practice Address - Fax:570-271-6002
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY379492080P0210X
PAMD4386422080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001425982Medicaid
KY64066269Medicaid
IN200440950Medicaid
IN200440950Medicaid
PA001425982Medicaid