Provider Demographics
NPI:1639240070
Name:PIERSON, DIANNE CAROL (MD)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:CAROL
Last Name:PIERSON
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 1:168 BATTERY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5285
Mailing Address - Country:US
Mailing Address - Phone:802-862-0836
Mailing Address - Fax:802-860-2399
Practice Address - Street 1:168 BATTERY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5285
Practice Address - Country:US
Practice Address - Phone:802-862-0836
Practice Address - Fax:802-860-2399
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04200048422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVT4557OtherBCBS
VTVT4557OtherBCBS