Provider Demographics
NPI:1225466915
Name:MEJIA, DIANA MARCELA (PA)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARCELA
Last Name:MEJIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 TUCSON AVE UNIT D
Mailing Address - Street 2:
Mailing Address - City:ANDREWS AIR FORCE BASE
Mailing Address - State:MD
Mailing Address - Zip Code:20762-5566
Mailing Address - Country:US
Mailing Address - Phone:407-902-4080
Mailing Address - Fax:240-348-4531
Practice Address - Street 1:5755 CEDAR LN STE 134
Practice Address - Street 2:HOWARD COUNTY GENERAL HOSPITAL
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2912
Practice Address - Country:US
Practice Address - Phone:410-884-4746
Practice Address - Fax:410-884-4749
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant