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NPI Code Detail

MEDICARE: DIANE HEMINGWAY

MEDICARE: DIANE HEMINGWAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician015698ME

General Provider Information

NPI Number : 1891774345
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE HEMINGWAY
Provider Business Mailing Address
First Line : 1735 CITY CENTER BLVD
Second Line :
City : ELIZABETH CITY
State : NC
Zip : 27909-8960
Country : US
Telephone Number : 252-338-2155
Fax Number : 252-338-7704
Provider Business Practice Location Address
First Line : 1735 CITY CENTER BLVD
Second Line :
City : ELIZABETH CITY
State : NC
Zip : 27909-8960
Country : US
Telephone Number : 252-338-2155
Fax Number : 252-338-7704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2006
Last Update Date : 12/14/2012

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