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General NPI Number Information
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NPI Number | 1871894808
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Entity Type | Individual
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Provider Name | DIANE ADAKU TACKIE PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 40 YORK RD STE 110
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City | TOWSON
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State | MD
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Zip | 21204-5243
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Country | US
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Telephone | 202-951-7942
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Fax | 202-971-1991
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Provider Business Mailing Address
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Address Line | 40 YORK RD STE 110
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City | TOWSON
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State | MD
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Zip | 21204-5243
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Country | US
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Telephone | 202-951-7942
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Fax | 202-971-1991
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | C04246
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License Number State | MD
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