Provider Demographics
NPI:1679515142
Name:DIACONU, IOANA M (MD)
Entity Type:Individual
Prefix:
First Name:IOANA
Middle Name:M
Last Name:DIACONU
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:PO BOX 2725
Mailing Address - Street 2:200
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98083-2725
Mailing Address - Country:US
Mailing Address - Phone:425-354-3723
Mailing Address - Fax:
Practice Address - Street 1:620 KIRKLAND WAY
Practice Address - Street 2:200
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6021
Practice Address - Country:US
Practice Address - Phone:425-889-5045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000419002084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1121037Medicaid
WAG8878201Medicare PIN
WA1121037Medicaid