Provider Demographics
NPI:1942284617
Name:LAURIN, DIANE AUDREY (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:AUDREY
Last Name:LAURIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:9420 KEY WEST AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3334
Practice Address - Country:US
Practice Address - Phone:301-279-9400
Practice Address - Fax:301-279-0313
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0057376207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD973006100Medicaid
MD973006100Medicaid
MDG00121Medicare UPIN