Provider Demographics
NPI:1356661169
Name:WHITEHEAD, DIANA ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ALEXANDER
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANA-FRANCES
Other - Middle Name:
Other - Last Name:COFFIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC DEPARTMENT OF GASTROENTEROLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-5218
Mailing Address - Fax:603-650-5225
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC DEPARTMENT OF GASTROENTEROLOGY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-5218
Practice Address - Fax:603-650-5225
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01946207R00000X
NH16144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine