Provider Demographics
NPI:1497835896
Name:DIAMOND, STEFANIE LYNN (PAC)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:LYNN
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 GREENLAND RD
Mailing Address - Street 2:SUITE C4
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4164
Mailing Address - Country:US
Mailing Address - Phone:603-431-5529
Mailing Address - Fax:603-436-6603
Practice Address - Street 1:875 GREENLAND RD
Practice Address - Street 2:SUITE C4
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4164
Practice Address - Country:US
Practice Address - Phone:603-431-5529
Practice Address - Fax:603-436-6603
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0141P204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAP0207Medicare ID - Type Unspecified
NHS32236Medicare UPIN