| Doctor Name: | MS. DIANNE REGINA JACKSON |
| NPI Number: | 1003193947 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | D0039496 |
| Business Practice Address: | 9601 Reistertown Rd Owings Mills, MD - 21117 |
| Business Phone Number: | 3013529763 |
| Business Fax Number: | |
| Mailing Address: | P.o. Box (561), LANHAM |
| State: | MD |
| Postal Code: | 20703 |
| Phone Number: | 3013529763 |
| Fax Number: | |
| NPI Enumeration Date: | 11/07/2011 |
| NPI Last Update Date: | 11/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | D0039496 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |