Provider Demographics
NPI:1750360947
Name:DOOKHAN, DIANNE B (MD)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:B
Last Name:DOOKHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 NORTH SHADELAND AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-1706
Mailing Address - Country:US
Mailing Address - Phone:317-275-8072
Mailing Address - Fax:317-275-8072
Practice Address - Street 1:568 RUIN CREEK RD
Practice Address - Street 2:SUITE 5
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2880
Practice Address - Country:US
Practice Address - Phone:252-492-4477
Practice Address - Fax:252-436-1899
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000401207ZB0001X, 207ZP0102X
VA0101225455207ZP0102X
WV23835207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1750360947Medicaid
VA00X556A03Medicare PIN
NCF98548Medicare UPIN
WVDO4277201Medicare PIN