Provider Demographics
NPI:1538155098
Name:ALTSCHER, DIANE C (EDD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:ALTSCHER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4067
Mailing Address - Country:US
Mailing Address - Phone:301-490-0550
Mailing Address - Fax:410-880-6874
Practice Address - Street 1:659A MAIN ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4067
Practice Address - Country:US
Practice Address - Phone:301-490-0550
Practice Address - Fax:410-880-6874
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1132103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG008OtherBC/BS OLD NUMBER
MD410231-01OtherBC/BS NEW NUMBER
MD217485OtherKAISER
MD002232OtherTRICARE
DC094OtherCAREFIRST FEDERAL
MD321899OtherMANAGED HEALTH NETWORK
MD410231-01OtherBC/BS NEW NUMBER
MD217485OtherKAISER