Provider Demographics
NPI:1356582720
Name:GERMOSEN, DIANA E (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:E
Last Name:GERMOSEN
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 1:4 LONGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4149
Mailing Address - Country:US
Mailing Address - Phone:718-264-7500
Mailing Address - Fax:
Practice Address - Street 1:100 ROCKFORD DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2120
Practice Address - Country:US
Practice Address - Phone:302-996-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00099652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry