Provider Demographics
NPI:1457442733
Name:DIAZ, MARIA CARMEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA CARMEN
Middle Name:G
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-1400
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1600 ROCKLAND ROAD
Practice Address - Street 2:NEMOURS/DUPONT HOSPITAL FOR CHILDREN
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-4000
Practice Address - Fax:302-651-4945
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC10007279207PP0204X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101141605Medicaid
NJ0033812Medicaid
SCQ07279Medicaid
MD4050649Medicaid
NY02656288Medicaid
014396T34Medicare PIN
PA101141605Medicaid