Healthcare Provider Details

I. General information

NPI: 1245338128
Provider Name (Legal Business Name): DIANA CHUONG PONSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANA CHUONG MD

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE DEPT OF OTOLARYNGOLOGY
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

24701 EUCLID AVE 3RD FLOOR
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 216-544-8684
  • Fax: 216-229-7969
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number35-090913
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD034843
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35.090913
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: