Provider Demographics
NPI:1982845038
Name:LAM, DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:LAM
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 1:13215 41ST AVE
Mailing Address - Street 2:SUITE CB
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3962
Mailing Address - Country:US
Mailing Address - Phone:718-321-3382
Mailing Address - Fax:
Practice Address - Street 1:13215 41ST AVE
Practice Address - Street 2:SUITE CB
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3962
Practice Address - Country:US
Practice Address - Phone:718-321-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250243207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400021713Medicare PIN