Healthcare Provider Details

I. General information

NPI: 1801900741
Provider Name (Legal Business Name): DIANA E SMALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 N BREIEL BLVD
MIDDLETOWN OH
45042
US

IV. Provider business mailing address

331 N BREIEL BLVD
MIDDLETOWN OH
45042
US

V. Phone/Fax

Practice location:
  • Phone: 513-424-1856
  • Fax: 513-424-1850
Mailing address:
  • Phone: 513-424-1856
  • Fax: 513-424-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35048561E
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: