Provider Demographics
NPI:1477011401
Name:HARRISON, DIANE D (MD, MPH)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:D
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 PHILIP PL
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3902
Mailing Address - Country:US
Mailing Address - Phone:610-659-3405
Mailing Address - Fax:
Practice Address - Street 1:236 PHILIP PL
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3902
Practice Address - Country:US
Practice Address - Phone:610-659-3405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042814E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD042814EOtherPENNSYLVANIA MEDICAL LICENSE