Provider Demographics
NPI:1790785145
Name:LUBKEMAN, DIANE H (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:H
Last Name:LUBKEMAN
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 1:31519 WINTERPLACE PKWY
Mailing Address - Street 2:STE 1
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804
Mailing Address - Country:US
Mailing Address - Phone:410-546-2500
Mailing Address - Fax:
Practice Address - Street 1:116 E FRONT ST
Practice Address - Street 2:STE A
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-1722
Practice Address - Country:US
Practice Address - Phone:410-546-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECI-0003154207W00000X
MDD0063035207W00000X
PAMD032840E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD174LM492Medicare PIN
DE018232A90Medicare PIN
DEP00265320Medicare PIN
B66624Medicare UPIN