1518034461 NPI number — MRS. DIANA D GALARIS MSSA

Table of content: MRS. DIANA D GALARIS MSSA (NPI 1518034461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518034461 NPI number — MRS. DIANA D GALARIS MSSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALARIS
Provider First Name:
DIANA
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSSA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIMMICK
Provider Other First Name:
DIANA
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSSA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518034461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 OLD HARMONY ROAD
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-737-9244
Provider Business Mailing Address Fax Number:
302-737-6244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 OLD HARMONY ROAD
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-737-9244
Provider Business Practice Location Address Fax Number:
302-737-6244
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  Q1 0000251 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000030415 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 228678 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000030416 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001392 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 172864 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".




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