Provider Demographics
NPI:1679530984
Name:GUTTERMAN, DIANE F (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:F
Last Name:GUTTERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:45 RAISIN TREE CIR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6376
Mailing Address - Country:US
Mailing Address - Phone:410-467-8975
Mailing Address - Fax:410-467-8975
Practice Address - Street 1:3501 SAINT PAUL ST
Practice Address - Street 2:SUITE 142
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2703
Practice Address - Country:US
Practice Address - Phone:410-467-8975
Practice Address - Fax:410-467-8975
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00228142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD322271300Medicaid
MD3758Medicare PIN
MD322271300Medicaid