Provider Demographics
NPI:1881782795
Name:ARVIN, DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:ARVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2852
Mailing Address - Country:US
Mailing Address - Phone:360-676-8212
Mailing Address - Fax:360-676-7557
Practice Address - Street 1:1202 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2852
Practice Address - Country:US
Practice Address - Phone:360-676-8212
Practice Address - Fax:360-676-7557
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027061207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1055664Medicaid
WA40264OtherPREMERA BLUE CROSS
WA911469439OtherTAX ID MISC INSURANCE
WA40264OtherREGENCE BLUE SHIELD
WA001400264Medicare ID - Type Unspecified
WA1055664Medicaid
WA40264OtherPREMERA BLUE CROSS