Provider Demographics
NPI:1225322183
Name:STAFFORD, DIANA GRACE (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:GRACE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:GRACE
Other - Last Name:NEWSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2021 CONCERT DR STE 202
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-8083
Mailing Address - Country:US
Mailing Address - Phone:757-668-4980
Mailing Address - Fax:
Practice Address - Street 1:2021 CONCERT DR STE 202
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-8083
Practice Address - Country:US
Practice Address - Phone:757-668-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA150668208000000X
VA010127929208000000X
MDD0077878208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics