Provider Demographics
NPI:1215911987
Name:WESTERBERG, DYANNE (DO)
Entity type:Individual
Prefix:
First Name:DYANNE
Middle Name:
Last Name:WESTERBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-342-2921
Mailing Address - Fax:856-968-8499
Practice Address - Street 1:3156 RIVER RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-4242
Practice Address - Country:US
Practice Address - Phone:856-963-0126
Practice Address - Fax:856-365-0279
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08313300207Q00000X
PAOS005360L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3423581000OtherAMERIHEATLH, KEYSTONE, IBC
051957OtherCIGNA
1667305OtherAETNA
1667307OtherAETNA
010046053OtherAMERICHOICE
1667308OtherAETNA
1667304OtherAETNA
1667304OtherAETNA
1667305OtherAETNA