Provider Demographics
NPI:1881662088
Name:BEGLEY, DIANE E (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:E
Last Name:BEGLEY
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 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-449-2732
Mailing Address - Fax:765-449-1196
Practice Address - Street 1:200 FERRY ST STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1172
Practice Address - Country:US
Practice Address - Phone:765-446-5161
Practice Address - Fax:765-446-5160
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040055A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100464270Medicaid
IN10780247OtherCAQH
IN000000304622OtherANTHEM PROVIDER NUMBER
INP00077639OtherRAILROAD MEDICARE
IN000000304622OtherANTHEM PROVIDER NUMBER
IN100464270Medicaid