1871577098 NPI number — GLORIA JANET DIAZ MD

Table of content: BRANDELYNN HEATH (NPI 1366804924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871577098 NPI number — GLORIA JANET DIAZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ
Provider First Name:
GLORIA
Provider Middle Name:
JANET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1871577098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2450 W HUNTING PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19129-1302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-707-3008
Provider Business Mailing Address Fax Number:
215-707-1387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 E ALLEGHENY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-4427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-926-3700
Provider Business Practice Location Address Fax Number:
215-926-3702
Provider Enumeration Date:
12/01/2005

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: 207V00000X , with the licence number:  MD053874L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001597753 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160032946 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 885573 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1041943 . This is a "KMHP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 519064 . This is a "COVENTRY HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0013242000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0581982 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2013029 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CD4829 . This is a "RAILROAD MEDICARE GROUP TPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0159775307 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 597586 . This is a "MEDICARE GROUP TPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2891 . This is a "BRAVO HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2Y3095 . This is a "HEALTH NET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5723452 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P416865 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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