Provider Demographics
NPI:1578528584
Name:NUGENT, DIANE (DO)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:NUGENT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-610-8051
Mailing Address - Fax:
Practice Address - Street 1:73 CORPORATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2847
Practice Address - Country:US
Practice Address - Phone:603-610-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16468207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3098429Medicaid
NH3098429Medicaid
F95185Medicare UPIN
MEMM6004Medicare ID - Type Unspecified
MEMM600401Medicare PIN
ME6542688OtherCIGNA
ME292110099Medicaid
MEG14473OtherHARVARD PILGRIM