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Individual

DIANA LEIGH THEOBALD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
424 SAVANNAH RD, LEWES, DE 19958-1462
(302) 645-3300
Mailing address
4709 COASTAL HWY UNIT 255, OCEAN CITY, MD 21842-3262

Taxonomy

Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
R225874
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MTX011833
CAREFIRST ADMINISTRATORS
MD
Enumeration date
03/05/2019
Last updated
06/11/2019
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