Provider Demographics
NPI:1356661169
Name:WHITEHEAD, DIANA ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ALEXANDER
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANA-FRANCES
Other - Middle Name:
Other - Last Name:COFFIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,
Mailing Address - Street 1:1838 GREENE TREE RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-7103
Mailing Address - Country:US
Mailing Address - Phone:410-602-7782
Mailing Address - Fax:410-602-9344
Practice Address - Street 1:535 OLD WESTMINSTER PIKE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6267
Practice Address - Country:US
Practice Address - Phone:410-876-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16144207R00000X
RILP01946207R00000X
MDD0081415207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine