Basic Information
| Provider Information | |||||||||
| NPI: | 1518934223 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANDAUER | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | HELEN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42 LAMBERT ST | ||||||||
| Address2: | STE 111 | ||||||||
| City: | STAUNTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 244012421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409324629 | ||||||||
| FaxNumber: | 5409324616 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 GREEN HILL DR | ||||||||
| Address2: | |||||||||
| City: | VERONA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 244822654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402484487 | ||||||||
| FaxNumber: | 5402485312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 05/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101051652 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010061571 | 05 | VA | MEDICAID |