Provider Demographics
NPI:1871765313
Name:DIAS RAYNAL, MARIA (APRN MS BC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DIAS RAYNAL
Suffix:
Gender:F
Credentials:APRN MS BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-1235
Mailing Address - Country:US
Mailing Address - Phone:301-320-2656
Mailing Address - Fax:
Practice Address - Street 1:5805 SPRINGFIELD DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-1235
Practice Address - Country:US
Practice Address - Phone:301-320-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR106890364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003286Medicare PIN