Provider Demographics
NPI:1366538761
Name:COLGAN, DIANE LESLEE (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LESLEE
Last Name:COLGAN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:9800 FALLS RD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3999
Mailing Address - Country:US
Mailing Address - Phone:301-299-6644
Mailing Address - Fax:301-299-6647
Practice Address - Street 1:9800 FALLS RD
Practice Address - Street 2:SUITE #105
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3999
Practice Address - Country:US
Practice Address - Phone:301-299-6644
Practice Address - Fax:301-299-6647
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-07-27
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Provider Licenses
StateLicense IDTaxonomies
MDD00089712086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B92801Medicare UPIN