Provider Demographics
NPI:1619174885
Name:DARR, DIANE MARGARETE (PA-C)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARGARETE
Last Name:DARR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16111 HARWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-3264
Mailing Address - Country:US
Mailing Address - Phone:240-566-3001
Mailing Address - Fax:240-566-3003
Practice Address - Street 1:CORP OHS FREDERICK 490-L PROSPECT BLVD
Practice Address - Street 2:490-L
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701
Practice Address - Country:US
Practice Address - Phone:240-566-3001
Practice Address - Fax:240-566-3003
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCOOO1130363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant