Provider Demographics
NPI:1801815535
Name:MAHAR, DIANA HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:HARRIS
Last Name:MAHAR
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 1:1301 PINOLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1384
Mailing Address - Country:US
Mailing Address - Phone:510-243-4213
Mailing Address - Fax:
Practice Address - Street 1:1301 PINOLE VALLEY RD
Practice Address - Street 2:DEPT. OF PEDIATRICS
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1384
Practice Address - Country:US
Practice Address - Phone:510-243-4213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77346208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA115716Medicare UPIN
CA00A773460Medicare ID - Type Unspecified