Healthcare Provider Details

I. General information

NPI: 1720173156
Provider Name (Legal Business Name): PHILOMENA JACINTHA DIAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 N. RURAL
INDIANAPOLIS IN
46205-2930
US

IV. Provider business mailing address

638 E. VERMONT
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-221-2306
  • Fax: 317-221-2336
Mailing address:
  • Phone: 317-510-8574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number01034355A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: