Healthcare Provider Details

I. General information

NPI: 1164604641
Provider Name (Legal Business Name): ROBERT ANDREW DIAMOND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W BROAD ST
BETHLEHEM PA
18018-5526
US

IV. Provider business mailing address

303 W BROAD ST
BETHLEHEM PA
18018-5526
US

V. Phone/Fax

Practice location:
  • Phone: 610-865-0311
  • Fax: 610-865-9458
Mailing address:
  • Phone: 610-865-0311
  • Fax: 610-865-9458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC002298L
License Number StatePA

VIII. Authorized Official

Name: ROBERT A DIAMOND
Title or Position: OWNER
Credential: DPM
Phone: 610-865-0311