Healthcare Provider Details

I. General information

NPI: 1841262656
Provider Name (Legal Business Name): DIANA PATRICIA CARMONA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLIERS WAY STE 201
WEIRTON WV
26062-5055
US

IV. Provider business mailing address

651 COLLIERS WAY STE 300
WEIRTON WV
26062-5058
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-4700
  • Fax:
Mailing address:
  • Phone: 304-797-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number35.097928
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD071348L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number26118
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: