Provider Demographics
NPI:1679708374
Name:QUEVEDO DIAZ, HENRY CHRISTIAN (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:CHRISTIAN
Last Name:QUEVEDO DIAZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:HENRY
Other - Middle Name:CHRISTIAN
Other - Last Name:QUEVEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:12 ST PAUL DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1035
Practice Address - Country:US
Practice Address - Phone:717-217-6886
Practice Address - Fax:717-217-6896
Is Sole Proprietor?:No
Enumeration Date:2009-05-25
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205735207RC0000X
CODR.0072323207RI0011X
PAMD466350207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology