1811181662 NPI number — DR. DIMA L DIAB M.D.

Table of content: DR. DIMA L DIAB M.D. (NPI 1811181662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811181662 NPI number — DR. DIMA L DIAB M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAB
Provider First Name:
DIMA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811181662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636256
Provider Second Line Business Mailing Address:
CENTRAL CREDENTIALING
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-6256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-585-5507
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 PIEDMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45219-4231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-475-7400
Provider Business Practice Location Address Fax Number:
513-475-8201
Provider Enumeration Date:
09/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  35.087616 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100037320 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200905180 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2821414 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".