Healthcare Provider Details

I. General information

NPI: 1487620126
Provider Name (Legal Business Name): CAROL A DIAMOND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 S HIGHLANDS AVE
MADISON WI
53705-1111
US

IV. Provider business mailing address

6002 S HIGHLANDS AVE
MADISON WI
53705-1111
US

V. Phone/Fax

Practice location:
  • Phone: 608-232-9316
  • Fax:
Mailing address:
  • Phone: 608-829-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number41717
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: