Provider Demographics
NPI:1427314160
Name:CHARLES, DIANE ISAACSON (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:ISAACSON
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:ISAACSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2111 LAUREL BUSH RD STE H
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6156
Mailing Address - Country:US
Mailing Address - Phone:410-569-3300
Mailing Address - Fax:
Practice Address - Street 1:10084 REISTERSTOWN RD STE 200B
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4096
Practice Address - Country:US
Practice Address - Phone:410-494-1369
Practice Address - Fax:410-494-2737
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09651600208000000X
MDD88487208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics