Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 0141P | NH |
NPI | 1497835896 |
---|---|
Provider Name | Stefanie Lynn Diamond |
First Address | Portsmouth, NH 03801-4164 |
Second Address | Portsmouth, NH 03801-4164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S32236 | (02) | NH |