Healthcare Provider Details

I. General information

NPI: 1518022177
Provider Name (Legal Business Name): DIANE E STABLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WOODSIDE CT
COLUMBIA MD
21046-1071
US

IV. Provider business mailing address

6355 WOODSIDE CT
COLUMBIA MD
21046-1071
US

V. Phone/Fax

Practice location:
  • Phone: 410-381-7171
  • Fax: 410-381-5137
Mailing address:
  • Phone: 410-381-7171
  • Fax: 410-381-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0032957
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: