Healthcare Provider Details

I. General information

NPI: 1952304537
Provider Name (Legal Business Name): MARK DIAMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 MCCOMAS AVE
KENSINGTON MD
20895-2826
US

IV. Provider business mailing address

2665 MCCOMAS AVE
KENSINGTON MD
20895-2826
US

V. Phone/Fax

Practice location:
  • Phone: 412-341-7288
  • Fax:
Mailing address:
  • Phone: 412-341-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD018122E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: