Provider Demographics
NPI:1982706966
Name:MATHESON, DIANNE HANEY (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:HANEY
Last Name:MATHESON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1004 1ST ST N
Mailing Address - Street 2:SUITE 370
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8766
Mailing Address - Country:US
Mailing Address - Phone:205-663-5547
Mailing Address - Fax:205-663-5547
Practice Address - Street 1:1004 1ST ST N
Practice Address - Street 2:SUITE 370
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8766
Practice Address - Country:US
Practice Address - Phone:205-663-5547
Practice Address - Fax:205-663-5547
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00013731208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4200986OtherAETNA PROVIDER NUMBER
AL51526786OtherBCBS PROVIDER NUMBER
AL009997865Medicaid
AL4200986OtherAETNA PROVIDER NUMBER