Provider Demographics
NPI:1245411602
Name:DEISTER, DIANA D (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:D
Last Name:DEISTER
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 1:258 HARVARD ST # 359
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2904
Mailing Address - Country:US
Mailing Address - Phone:617-520-4854
Mailing Address - Fax:
Practice Address - Street 1:43 NAPLES RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5768
Practice Address - Country:US
Practice Address - Phone:617-520-4854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2562622084P0804X
RIMD139892084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry