=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346449279
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANE GUENIN FOX M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 08/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 E DONNER AVE SUITE 101
-----------------------------------------------------
City | MONESSEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15062-1388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-684-8999
-----------------------------------------------------
Fax | 724-684-8983
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 E DONNER AVE SUITE 101
-----------------------------------------------------
City | MONESSEN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15062-1388
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-684-8999
-----------------------------------------------------
Fax | 724-684-8983
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD 045357L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------