Diane Adaku Tackie, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

C04246 Issued in MD

Practice address

1395 Piccard Dr Ste 200
Rockville, MD 20850-4348

Phone

(202) 951-7942

Fax

(202) 971-1991

NPI assigned

Nov 8, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Diane Tackie Granillo Professional name

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: diane.tackie@marcelluscephas.chartmakerdirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Diane Tackie Granillo, LLC

  • Medical Physician Assistant
  • Rockville, MD
  • NPI 1972393171
  NPD
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773878400000",
    "number": "1871894808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 PICCARD DR STE 200",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208504348",
            "telephone_number": "202-951-7942",
            "fax_number": "202-971-1991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1395 PICCARD DR STE 200",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208504348",
            "telephone_number": "202-951-7942",
            "fax_number": "202-971-1991"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1350 Connecticut Ave NW Ste 1250",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200361728",
            "country_code": "US",
            "telephone_number": "888-663-6331",
            "fax_number": "415-252-7176",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1331 H St NW Ste 200",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200054706",
            "country_code": "US",
            "telephone_number": "888-803-3370",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "40 York Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Towson",
            "state": "MD",
            "postal_code": "212045243",
            "country_code": "US",
            "telephone_number": "202-951-7942",
            "fax_number": "202-971-1991",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TACKIE",
        "first_name": "DIANE",
        "middle_name": "ADAKU",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-08",
        "last_updated": "2026-03-19",
        "certification_date": "2026-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DC",
            "license": "PA031403",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C04246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "TACKIE GRANILLO",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Medical Physician Assistant in Rockville, MD
• Providers in Rockville, MD by specialty
• Medical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.