Provider Demographics
NPI:1942504030
Name:EMANUEL, DIANA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 YORK RD
Mailing Address - Street 2:VAN BOKKELEN HALL, LOWER LEVEL
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21252-0001
Mailing Address - Country:US
Mailing Address - Phone:410-704-3095
Mailing Address - Fax:410-704-6303
Practice Address - Street 1:8000 YORK RD
Practice Address - Street 2:VAN BOKKELEN HALL, LOWER LEVEL
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21252-0001
Practice Address - Country:US
Practice Address - Phone:410-704-3095
Practice Address - Fax:410-704-6303
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00712231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN199 0005OtherFEDERAL BLUE CHOICE
60771701OtherBLUE CROSS BLUE SHIELD
MDL030891ZMedicare PIN