Healthcare Provider Details

I. General information

NPI: 1649345166
Provider Name (Legal Business Name): DIANA CHENG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 04/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W PRESTON ST ROOM 313
BALTIMORE MD
21201-2301
US

IV. Provider business mailing address

20 AIGBURTH RD
TOWSON MD
21286-1105
US

V. Phone/Fax

Practice location:
  • Phone: 410-767-6719
  • Fax: 410-333-5233
Mailing address:
  • Phone: 410-767-6719
  • Fax: 410-333-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD36093
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: