Provider Demographics
NPI:1386761815
Name:DIAMOND, WENDI TAMA (MD)
Entity type:Individual
Prefix:DR
First Name:WENDI
Middle Name:TAMA
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1150 MAIN STREET
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3053
Mailing Address - Country:US
Mailing Address - Phone:617-834-4673
Mailing Address - Fax:858-673-8519
Practice Address - Street 1:1150 MAIN STREET SUITE 9
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:617-834-4673
Practice Address - Fax:833-641-1964
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2021-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG879802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ046670Medicare ID - Type Unspecified