Provider Demographics
NPI:1386751105
Name:DEVEINES, DIANE JEAN (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:JEAN
Last Name:DEVEINES
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 1:2215 BURDETT AVE
Mailing Address - Street 2:BEHAVIORAL HEALTH DEPT
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2466
Mailing Address - Country:US
Mailing Address - Phone:518-271-3300
Mailing Address - Fax:
Practice Address - Street 1:2215 BURDETT AVE
Practice Address - Street 2:BEHAVIORAL HEALTH DEPT
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2466
Practice Address - Country:US
Practice Address - Phone:518-271-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1361292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00276902Medicare ID - Type UnspecifiedRR MEDICARE - AMH
NYH70029Medicare ID - Type UnspecifiedUPSTATE MCR - SAMARITAN
NYRA1499Medicare ID - Type UnspecifiedUPSTATE MEDICARE AMH
E47356Medicare UPIN