Provider Demographics
NPI:1114196920
Name:MATHEWS, DIANNE SEAMAN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:SEAMAN
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:CLINIC
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-0248
Mailing Address - Country:US
Mailing Address - Phone:704-843-6000
Mailing Address - Fax:
Practice Address - Street 1:7601 RADIN RD
Practice Address - Street 2:CLINIC
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-9158
Practice Address - Country:US
Practice Address - Phone:800-890-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95001352083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine