Provider Demographics
NPI:1730169830
Name:PINE, DIANE SPAGNOLI (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:SPAGNOLI
Last Name:PINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:J
Other - Last Name:SPAGNOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:45 READE PLACE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-483-6299
Mailing Address - Fax:845-483-6376
Practice Address - Street 1:45 READE PLACE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-483-6299
Practice Address - Fax:845-483-6376
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192824207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDP037S6820OtherBCBS
NY01674024Medicaid
NYDP037S6820OtherBCBS
P00092730Medicare PIN
NYA400131273Medicare PIN
NY44N681Medicare ID - Type Unspecified
NY01674024Medicaid