Provider Demographics
NPI:1588076582
Name:RHODEN, DIANE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:RHODEN
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 1:8714 129TH ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2709
Mailing Address - Country:US
Mailing Address - Phone:646-872-9549
Mailing Address - Fax:
Practice Address - Street 1:280 HENRY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4816
Practice Address - Country:US
Practice Address - Phone:212-227-8401
Practice Address - Fax:212-349-9385
Is Sole Proprietor?:No
Enumeration Date:2014-05-24
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2719041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine