Provider Demographics
NPI:1689874877
Name:NATHAN, DIANE LI (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LI
Last Name:NATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-0525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 ENGLE STREET
Practice Address - Street 2:DEPT OF RADIOLOGY, ENGLEWOOD HOSPITAL AND MEDICAL CTR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-894-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD603193642085R0202X
FLME1706762085R0202X
PAMD4423362085R0202X
NJ25MA120238002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2030315Medicaid
WAG8921214OtherPTAN-UNION AVENUE OPEN MRI
WAP01238729OtherRR MEDICARE-CMBC
WAG8921215OtherPTAN-MEDICAL IMAGING ON 1ST
WAP01238727OtherRR MEDICARE-TRA KING CO
WAP01238732OtherRR MEDICARE-UAOM
WAG8921211OtherPTAN-CAROL MILGARD BREAST CENTER
WAG8921213OtherPTAN-TACOMA RADIOLOGICAL ASSOCIATES, PIERCE CO