1184628869 NPI number — DIANA M DONATI M.D.

Table of content: DIANA M DONATI M.D. (NPI 1184628869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184628869 NPI number — DIANA M DONATI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONATI
Provider First Name:
DIANA
Provider Middle Name:
M
Provider Name Prefix Text:
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:
FREY
Provider Other First Name:
DIANE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184628869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 JASONWAY AVE
Provider Second Line Business Mailing Address:
SUITE G-2
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43214-4333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-459-4675
Provider Business Mailing Address Fax Number:
614-459-4675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 JASONWAY AVE
Provider Second Line Business Practice Location Address:
SUITE G-2
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43214-4333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-459-4675
Provider Business Practice Location Address Fax Number:
614-459-4675
Provider Enumeration Date:
06/09/2005

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: 207R00000X , with the licence number:  35077599 , 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: 2177031 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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