Provider Demographics
NPI:1831270610
Name:SADDEL, DIANA LORRAINE (DO)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LORRAINE
Last Name:SADDEL
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 1:3 JASPER JOHNS WAY
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-7218
Mailing Address - Country:US
Mailing Address - Phone:856-809-0954
Mailing Address - Fax:
Practice Address - Street 1:543 EGG HARBOR RD
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2335
Practice Address - Country:US
Practice Address - Phone:856-256-2063
Practice Address - Fax:856-256-2064
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB52186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0723801Medicaid
NJSA609579Medicare ID - Type Unspecified
NJE65166Medicare UPIN