Healthcare Provider Details

I. General information

NPI: 1740222611
Provider Name (Legal Business Name): DIANE LYNN MCDONALD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W LOMBARD ST UNIVERSITY OF MARYLAND PEDIATRIC EMERGENCY DEPT
BALTIMORE MD
21201-1513
US

IV. Provider business mailing address

4701 DOWER DR
ELLICOTT CITY MD
21043-6453
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6335
  • Fax: 410-328-0987
Mailing address:
  • Phone: 410-750-7743
  • Fax: 410-750-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME114640
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberD0036878
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: