Provider Demographics
NPI:1578649745
Name:SCHWEITZER, DIANE JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:JOAN
Last Name:SCHWEITZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13 JEFFERSON ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467
Mailing Address - Country:US
Mailing Address - Phone:617-277-9084
Mailing Address - Fax:
Practice Address - Street 1:464 HILLSIDE AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1227
Practice Address - Country:US
Practice Address - Phone:781-449-5170
Practice Address - Fax:781-449-5171
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34757207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3089584Medicaid
MA3089584Medicaid
B72804Medicare UPIN