Provider Demographics
NPI:1295712453
Name:JOHANSON, DIANA E (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:E
Last Name:JOHANSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:193 LOCUST ST
Mailing Address - Street 2:STE. 2
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2066
Mailing Address - Country:US
Mailing Address - Phone:413-584-8700
Mailing Address - Fax:413-584-1714
Practice Address - Street 1:193 LOCUST ST
Practice Address - Street 2:STE. 2
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2066
Practice Address - Country:US
Practice Address - Phone:413-584-8700
Practice Address - Fax:413-584-1714
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-03-15
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Provider Licenses
StateLicense IDTaxonomies
MA216773208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000026863OtherBMC
MA04-2817581OtherUNICARE/GIC
MA33435OtherHEALTH NEW ENGLAND
MA04-2817581OtherNORTHEAST HEALTH DIRECT
MA04-2817581OtherPIONEER
MAAA2007OtherHARVARD PILGRIM
MA04-2817581OtherNORTHEAST HEALTHCARE ALLI
MA04-2817581OtherPLAN VISTA
MA216773OtherCONNECITCARE
MA467270OtherTUFTS
MA04-2817581OtherPRIVATE HEALTHCARE SYSTEM
MA5306427001OtherCIGNA
MA0189651Medicaid
MA04-2817581OtherCONSOLIDATED
MA04-2817581OtherGREAT-WEST
MAJ26513OtherBCBSMA
MA04-2817581OtherNORTH AMERCIAN PREFERRED
MA3410756OtherAETNA
MA0189651Medicaid