Provider Demographics
NPI:1891740775
Name:CHARLAND, DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:CHARLAND
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 1:71 KNIGHT LN
Mailing Address - Street 2:SUITE 10
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-4432
Mailing Address - Country:US
Mailing Address - Phone:802-872-7001
Mailing Address - Fax:
Practice Address - Street 1:71 KNIGHT LN
Practice Address - Street 2:SUITE 10
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4432
Practice Address - Country:US
Practice Address - Phone:802-872-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010080207VG0400X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2378Medicaid
VTP00244985OtherRAIL ROAD MEDICARE
VTVN2378Medicare PIN
VT0VN2378Medicaid