Basic Information
| Provider Information | |||||||||
| NPI: | 1376740746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHARUCHA-GOEBEL | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37215 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212973215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024765000 | ||||||||
| FaxNumber: | 3015723544 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 MICHIGAN AVE NW | ||||||||
| Address2: | CHILDREN'S NATIONAL MEDICAL CENTER - DEPT NEUROLOGY | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200102916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024762120 | ||||||||
| FaxNumber: | 2024762864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 07/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MT190249 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2084N0402X | MD041530 | DC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
No ID Information.