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NPI Code Detail

MEDICARE: DIANE VAN DE MARK MD

MEDICARE:   DIANE  VAN DE MARK  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VX0000XObstetrics PhysicianME89688FL

General Provider Information

NPI Number : 1437155033
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE VAN DE MARK MD
Provider Business Mailing Address
First Line : 8110 ROYAL PALM BLVD
Second Line : STE 108
City : CORAL SPRINGS
State : FL
Zip : 33065-5742
Country : US
Telephone Number : 954-341-8288
Fax Number : 954-341-5156
Provider Business Practice Location Address
First Line : 8110 ROYAL PALM BLVD
Second Line : STE 108
City : CORAL SPRINGS
State : FL
Zip : 33065-5742
Country : US
Telephone Number : 954-341-8288
Fax Number : 954-341-5156
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 07/08/2007

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