Individual
DIANE L WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(860) 679-4600
(860) 679-1248
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
032383
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1323831
—
CT
Enumeration date
07/12/2005
Last updated
07/11/2022
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