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General NPI Number Information
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NPI Number | 1366538761
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Entity Type | Individual
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Provider Name | DIANE LESLEE COLGAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 9800 FALLS RD SUITE #105
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City | POTOMAC
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State | MD
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Zip | 20854-3999
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Country | US
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Telephone | 301-299-6644
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Fax | 301-299-6647
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Provider Business Mailing Address
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Address Line | 9800 FALLS RD SUITE #105
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City | POTOMAC
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State | MD
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Zip | 20854-3999
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Country | US
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Telephone | 301-299-6644
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Fax | 301-299-6647
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | D0008971
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License Number State | MD
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