Provider Demographics
NPI:1851401004
Name:DUMITRASCU, DIANA CRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:CRISTINA
Last Name:DUMITRASCU
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 1:1139 E WINDING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7232
Mailing Address - Country:US
Mailing Address - Phone:208-938-8887
Mailing Address - Fax:208-938-2791
Practice Address - Street 1:1139 E WINDING CREEK DR
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7232
Practice Address - Country:US
Practice Address - Phone:208-938-8887
Practice Address - Fax:208-938-2791
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-13307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine