Healthcare Provider Details

I. General information

NPI: 1043372543
Provider Name (Legal Business Name): DIANE M ROSTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MECHANIC ST SUITE 360 RECOVERY CENTER
LEBANON NH
03766
US

IV. Provider business mailing address

9 HANOVER ST SUITE 2 WEST CENTRAL SERVICES INC
LEBANON NH
03766
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-5610
  • Fax: 603-448-8260
Mailing address:
  • Phone: 603-448-0126
  • Fax: 603-448-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7851
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number8369
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: