Provider Demographics
NPI:1629029574
Name:PINGETON, DIANE (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:PINGETON
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 1:100 MLK JR. BOULEVARD
Mailing Address - Street 2:STE 300
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608
Mailing Address - Country:US
Mailing Address - Phone:508-755-4861
Mailing Address - Fax:508-752-1392
Practice Address - Street 1:100 MLK JR BLVD
Practice Address - Street 2:STE 300
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1209
Practice Address - Country:US
Practice Address - Phone:508-755-4861
Practice Address - Fax:508-752-1392
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA155890207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0017872OtherNEIGHBORHOOD HEALTH
155890OtherTUFTS
MA3186253Medicaid
98878703OtherNETWORK HEALTH
34464OtherFALLON
137817OtherHARVARD PILGRIM
MAJ19071OtherBCBS
MAA28411Medicare ID - Type Unspecified
MA3186253Medicaid