Provider Demographics
NPI:1710958236
Name:KISTLER, DIANE L (DO)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:KISTLER
Suffix:
Gender:F
Credentials:DO
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 1327
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-1327
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:603-527-7038
Practice Address - Street 1:5 ACADEMY DRIVE
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03256
Practice Address - Country:US
Practice Address - Phone:603-744-5377
Practice Address - Fax:603-744-8165
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30221276Medicaid
NHG80435Medicare UPIN
NHRE6366Medicare ID - Type Unspecified