Provider Demographics
NPI:1285052803
Name:SPELL, DIANA NICOLE (MD, MBA)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:NICOLE
Last Name:SPELL
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR # 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-5412
Mailing Address - Fax:
Practice Address - Street 1:JOHNS HOPKINS COMMUNITY PHYSICIANS - ODENTON
Practice Address - Street 2:1106 ANNAPOLIS ROAD
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113
Practice Address - Country:US
Practice Address - Phone:410-874-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0085372208000000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program