Provider Demographics
NPI:1376896605
Name:PRINCE, DIANE R
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:R
Last Name:PRINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 RANDOLPH RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1209
Mailing Address - Country:US
Mailing Address - Phone:202-345-7852
Mailing Address - Fax:
Practice Address - Street 1:43 RANDOLPH RD
Practice Address - Street 2:SUITE 215
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1209
Practice Address - Country:US
Practice Address - Phone:202-345-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications