Provider Demographics
NPI:1811188436
Name:REINHARDT, DIANA (DO)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 AMERICAN WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4672
Mailing Address - Country:US
Mailing Address - Phone:423-392-6700
Mailing Address - Fax:423-830-7455
Practice Address - Street 1:2004 AMERICAN WAY STE 207
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4672
Practice Address - Country:US
Practice Address - Phone:423-392-6700
Practice Address - Fax:423-830-7455
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV2331208000000X
TNDO2189208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program