Healthcare Provider Details

I. General information

NPI: 1912128976
Provider Name (Legal Business Name): FRAYDA DIAMOND RNC, CNM, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26005 RIDGE RD SUITE 200
DAMASCUS MD
20872-1892
US

IV. Provider business mailing address

1530 KEY BLVD APT PH26
ARLINGTON VA
22209-1531
US

V. Phone/Fax

Practice location:
  • Phone: 301-414-2300
  • Fax: 301-414-2306
Mailing address:
  • Phone: 703-528-6679
  • Fax: 703-528-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAC000145
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number000 1179335
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: