MEDICARE: DR. DIANE H LUBKEMAN M.D.

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
1	207W00000X	Ophthalmology Physician	CI-0003154	DE
2	207W00000X	Ophthalmology Physician	D0063035	MD
3	207W00000X	Ophthalmology Physician	MD032840E	PA

General Provider Information

NPI Number	:	1790785145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE H LUBKEMAN M.D.

Provider Business Mailing Address
First Line	:	31519 WINTERPLACE PKWY
Second Line	:	STE 1
City	:	SALISBURY
State	:	MD
Zip	:	21804
Country	:	US
Telephone Number	:	410-546-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 E FRONT ST
Second Line	:	STE A
City	:	LAUREL
State	:	DE
Zip	:	19956-1722
Country	:	US
Telephone Number	:	410-546-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	01/31/2008

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