Provider Demographics
NPI:1497714802
Name:BOYKIN, DIANE C (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12009 SHADYSTONE TER
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2594
Mailing Address - Country:US
Mailing Address - Phone:240-305-4906
Mailing Address - Fax:
Practice Address - Street 1:6501 BALTIMORE NATIONAL PIKE STE D
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3923
Practice Address - Country:US
Practice Address - Phone:667-234-8790
Practice Address - Fax:667-234-8791
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057865207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0037OtherCAREFIRST-DC
MD403917300Medicaid
MD617418-04OtherCAREFIRST-MD
MD617418-04OtherCAREFIRST-MD
H75209Medicare UPIN