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General NPI Number Information
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NPI Number | 1245338128
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Entity Type | Individual
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Provider Name | DIANA CHUONG PONSKY MD
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVE DEPT OF OTOLARYNGOLOGY
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-544-8684
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Fax | 216-229-7969
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Provider Business Mailing Address
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Address Line | 24701 EUCLID AVE 3RD FLOOR
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City | EUCLID
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State | OH
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Zip | 44117-1714
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 35-090913
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | MD034843
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 35.090913
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License Number State | OH
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