Provider Demographics
NPI:1902888472
Name:ANGSTADT, DIANE M (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:ANGSTADT
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 FOREST HILLS DR
Mailing Address - Street 2:SUITE 38
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1099
Mailing Address - Country:US
Mailing Address - Phone:717-540-5353
Mailing Address - Fax:717-540-5151
Practice Address - Street 1:2215 FOREST HILLS DR
Practice Address - Street 2:SUITE 38
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1099
Practice Address - Country:US
Practice Address - Phone:717-540-5353
Practice Address - Fax:717-540-5151
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039381E2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA617504Medicare ID - Type UnspecifiedPROVIDER NUMBER
PAE55866Medicare UPIN