Provider Demographics
NPI:1740716000
Name:DIDDAMS, MAXWELL JOHANNES (MD)
Entity type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:JOHANNES
Last Name:DIDDAMS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1090 NE GATEWAY CT NE STE 201
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2423
Mailing Address - Country:US
Mailing Address - Phone:704-403-7770
Mailing Address - Fax:704-403-7779
Practice Address - Street 1:1090 NE GATEWAY CT NE STE 201
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2423
Practice Address - Country:US
Practice Address - Phone:704-403-7770
Practice Address - Fax:704-403-7779
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC227243207R00000X
NC2021-00610207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine