Provider Demographics
NPI:1912011529
Name:DIANE S LEBEDEFF DPM PA
Entity Type:Organization
Organization Name:DIANE S LEBEDEFF DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEBEDEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-245-8104
Mailing Address - Street 1:55 BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4501
Mailing Address - Country:US
Mailing Address - Phone:443-992-1275
Mailing Address - Fax:410-647-5776
Practice Address - Street 1:273 PENINSULA FARM RD STE E
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1012
Practice Address - Country:US
Practice Address - Phone:410-647-4534
Practice Address - Fax:410-647-8997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1141600001Medicare NSC
MD113MMedicare PIN