1821092792 NPI number — DR. AMY R DIAMOND MD

Table of content: DR. AMY R DIAMOND MD (NPI 1821092792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821092792 NPI number — DR. AMY R DIAMOND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAMOND
Provider First Name:
AMY
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
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:
1821092792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
430 E OAKVIEW DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WAYNESBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15370-9729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-627-8582
Provider Business Mailing Address Fax Number:
724-627-7756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
430 E OAKVIEW DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WAYNESBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15370-9729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-627-8582
Provider Business Practice Location Address Fax Number:
724-627-7756
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: 207Q00000X , with the licence number:  MD068043L , 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: 331193 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 250117 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017789730001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2305348 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101021 . This is a "THREE RIVERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P001714 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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