Provider Demographics
NPI:1821207820
Name:MCKENZIE, DIANE FLORENCE (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:FLORENCE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8140 ASHTON AVENUE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5698
Mailing Address - Country:US
Mailing Address - Phone:703-361-3128
Mailing Address - Fax:703-361-3670
Practice Address - Street 1:8140 ASHTON AVENUE
Practice Address - Street 2:SUITE 120
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5698
Practice Address - Country:US
Practice Address - Phone:703-361-3128
Practice Address - Fax:703-361-3670
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101039728207W00000X
DCMD15956207W00000X
MDD34178207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C88934Medicare UPIN