Provider Demographics
NPI:1265480883
Name:QUIBELL, DIANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:
Last Name:QUIBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:
Other - Last Name:FRUSTACI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:422 WORCESTER ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5341
Mailing Address - Country:US
Mailing Address - Phone:781-431-0002
Mailing Address - Fax:781-237-2022
Practice Address - Street 1:422 WORCESTER ST
Practice Address - Street 2:SUITE 105
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5341
Practice Address - Country:US
Practice Address - Phone:781-431-0002
Practice Address - Fax:781-237-2022
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F55228Medicare UPIN
J13696Medicare ID - Type Unspecified