Provider Demographics
NPI:1104905231
Name:DROZDOWICZ, DIANA HERNANDEZ (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:HERNANDEZ
Last Name:DROZDOWICZ
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 1:3115 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2901
Mailing Address - Country:US
Mailing Address - Phone:215-840-4624
Mailing Address - Fax:804-451-0535
Practice Address - Street 1:3115 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2901
Practice Address - Country:US
Practice Address - Phone:215-840-4624
Practice Address - Fax:804-451-0535
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95733208100000X
VA01012564342081P0301X, 208100000X
MI4301099875208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1104905231Medicaid
MI4301099875OtherSTATE OF MICHIGAN