Active NPI
Elisa Maria Diaz, D.O.
- Family Medicine Physician
- Skowhegan, ME
National Provider Identifier
1972915411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- DO2761
- Practice address
- 46 Fairview Ave # 111
Skowhegan, ME 04976 - Phone
- (207) 474-0905
- NPI assigned
- Jun 2, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS14951 | FL | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | DO2761 | ME | Primary |
Addresses
Primary practice location
46 Fairview Ave # 111
Skowhegan, ME 04976
Mailing address
1211 SE 6TH St
Cape Coral, FL 33990-2603
Phone (631) 745-5001
Other practice location 1
240 Meeting House Ln
Southampton, NY 11968-5009
Phone (631) 726-8200
Other practice location 2
39200 Hooker Hwy
Belle Glade, FL 33430-5368
Phone (561) 996-6571
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS14951 | FL | MD | Family Medicine Physician |
| DO2761 | ME | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528329600000",
"number": "1972915411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1211 SE 6TH ST",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339902603",
"telephone_number": "631-745-5001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "46 FAIRVIEW AVE # 111",
"city": "SKOWHEGAN",
"state": "ME",
"postal_code": "04976",
"telephone_number": "207-474-0905"
}
],
"practiceLocations": [
{
"address_1": "240 Meeting House Ln",
"address_purpose": "LOCATION",
"city": "Southampton",
"state": "NY",
"postal_code": "119685009",
"country_code": "US",
"telephone_number": "631-726-8200",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "39200 Hooker Hwy",
"address_purpose": "LOCATION",
"city": "Belle Glade",
"state": "FL",
"postal_code": "334305368",
"country_code": "US",
"telephone_number": "561-996-6571",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DIAZ",
"first_name": "ELISA",
"middle_name": "MARIA",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-02",
"last_updated": "2018-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "OS14951",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ME",
"license": "DO2761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Skowhegan, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.