Provider Demographics
NPI:1841219359
Name:DEIGNAN, DIANNA (MD)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:DEIGNAN
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:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-0593
Mailing Address - Country:US
Mailing Address - Phone:609-463-2755
Mailing Address - Fax:609-463-2757
Practice Address - Street 1:211 N MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2163
Practice Address - Country:US
Practice Address - Phone:609-536-8272
Practice Address - Fax:609-536-8273
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226615207Q00000X
NJ25MA08684300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0270741Medicaid
NJ175408WXTMedicare PIN