Healthcare Provider Details

I. General information

NPI: 1689584534
Provider Name (Legal Business Name): RAEGAN DIANE HARE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

IV. Provider business mailing address

1307 STREAMVIEW RD
BEL AIR MD
21015-5034
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12044
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: