Healthcare Provider Details

I. General information

NPI: 1972580181
Provider Name (Legal Business Name): DIANE TALLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 THOMAS LN SUITE 3-G
COLUMBUS OH
43214-1419
US

IV. Provider business mailing address

500 THOMAS LN SUITE 3-G
COLUMBUS OH
43214-1419
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-7732
  • Fax: 614-457-4346
Mailing address:
  • Phone: 614-457-7732
  • Fax: 614-457-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35-03-7692
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: