Provider Demographics
NPI:1821554924
Name:DIAZ ECKER, LISSA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LISSA
Middle Name:MARIE
Last Name:DIAZ ECKER
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 1:100 COMMERCE LN APT 502
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6262
Mailing Address - Country:US
Mailing Address - Phone:240-205-2732
Mailing Address - Fax:
Practice Address - Street 1:100 COMMERCE LN APT 502
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6262
Practice Address - Country:US
Practice Address - Phone:240-205-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231131-1207V00000X
MDD0098176207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology